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Advocacy, justice and empowerment

Rick Henderson and Mike Pochin



First published in Great Britain in September 2001 by

The Policy Press
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The Policy Press, 2001
ISBN 978 1 86134 306 2
Rick Henderson is Project Director of Advocacy Across London and
Mike Pochin is a coordinator of Dorset Advocacy.
The right of Rick Henderson and Mike Pochin to be identified as the
authors of this work has been asserted by them in accordance with the
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What is advocacy?


Issues in contemporary advocacy



Problems in measuring advocacy outcomes



What is advocacy for?



Developing an advocacy culture



Looking at standards


seven Learning, skills and validation





References and further reading





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The authors would like to thank the following for their contributions
to the writing of this book:
Hugh Farrell
Robert Weetman
Steve Turner
Sylvia Ellarby
Sally Carr
Joan Taylor
Tricia Banks
Terry and Anne Whitfield
Kathy West
Ukamaka and Tokunbo Bogunjoko
Dorset Health Authority
Advocacy 2000
Drumchapel Advocacy Project
The Advocacy Project (Glasgow)
Merchiston Advocacy Project
Independent Advocacy Service (Southwark)
Southwark Community Care Forum
Advocacy Service Action Project (ASAP)
Choices Advocacy
In addition, we would like to thank all at Dorset Advocacy, and our
long-suffering families.



Books on advocacy, as opposed to self-advocacy, are relatively

uncommon. This is surprising given the range and number of advocacy
schemes operating within the United Kingdom, all of which reflect
in one way or another the core belief that advocacy plays an essential
part in securing the rights and protecting the interests of the individual.
It is surprising, too, given that advocacy is generally acknowledged to
play an important, perhaps a crucial role in the implementation of
community care. The concept of advocacy is prominent in local
community care plans and charters and in long-stay hospital closure
plans. Even central government, which has toyed uneasily with
advocacy since the stalling of the 1986 Disabled Persons Act, has now
apparently signed up to the idea; advocacy, in the form of Patient
Advocacy and Liaison Services (PALS) is to be the lynchpin of this
governments National Health Service (NHS) reforms in England
and Wales. More recently still, the publication of Valuing people:A new
strategy for learning disability for the 21st century (DoH, 2001) promises
national government funding for the development of advocacy
schemes. With mental health reforms in England and Scotland also
likely to accord a central role to advocacy, its significance is no longer
in doubt.
Why then is there so little literature on advocacy? Two possible
reasons have to do with the priorities of advocacy schemes themselves.
Citizen advocacy, which was probably the first model of advocacy to
become established in the UK, has an inherent suspicion of academic
research. It is felt that to research advocacy is to treat it as an
intervention and to clientise those it supports, thereby thwarting a
key aim of citizen advocacy, which is to promote partners access to,
and acceptance within, the life of the community. Second, the stress
laid upon confidentiality by all models of advocacy has led to an
understandable reluctance to discuss actual advocacy processes in the
public arena.
A third reason may lie in the great diversity of advocacy models
now existing within the UK. Professional casework advocacy, citizen
advocacy, peer advocacy and volunteer advocacy each have their
committed followers who will tend to view their form of advocacy

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as the best; the debate is only sharpened by the need to compete for
scarce funding. The substantial differences between, say, a citizen
advocacy scheme that develops advocacy through long-term voluntary
partnerships and a scheme that offers short episodes of representation
by a trained, paid worker have led people to wonder whether advocacy
is really a single concept at all, or simply a name which happens to
have been given to a series of more or less separate activities. What is,
or is not, true advocacy?
To attempt to write a book about advocacy is to encounter all of
these problems, and others besides. We believe the attempt is
worthwhile, for several reasons.
First and most simply, advocacy is a force for good, and deserves to
be celebrated. This book has been inspired by contact with users of
advocacy and with advocacy schemes over a number of years. It is
written in the belief that advocacy can bring about significant change
not only in the lives of those it supports, but also in social awareness.
Second, advocacy in the UK is facing a series of threats and
dilemmas. In part, these reflect the difficulties which invariably beset
voluntary sector activities, especially with regard to funding. But the
problems also go deeper. As advocacy moves up the political agenda
so questions about the nature and quality of advocacy processes are
thrown into sharp relief. What sort of advocacy should people be
entitled to? What distinguishes good advocacy from bad? Unless the
advocacy movement can answer these questions, there is a danger
that with funding and recognition there may come the imposition of
inappropriate standards. Indeed, the proof of Best Value required by
local statutory funders of advocacy already threatens to undermine
some of its core principles, and to merge its identity with that of
wider service provision. Taken together with the recent
announcement that Community Health Councils are to be replaced
with PALS among other measures (in England at least), it is possible
to predict troubled times for the advocacy movement. This book
describes many of these challenges and draws out their implications.
It will be suggested that the best way for the independent advocacy
movement to counter such difficulties is to demonstrate the integrity
and effectiveness of advocacy on its own terms. A third aim of the
book, therefore, is to explore the ideas that lie at the heart of advocacy.
What sort of perceptions lie behind the different forms of advocacy,
and what sort of benefits do they bring about? By clarifying what
advocacy is for, it may be possible to lay the foundations for what
Dorothy Atkinson calls an autonomous advocacy culture (Atkinson,



1999, p 25). Although the features of such a culture are far from
being universally understood or even particularly well defined, there
is a real desire within the advocacy movement for a sense of unity,
collaboration and coherence. Such a network of ideas and practices
may help to prevent advocacy from being diluted or undermined.
Finally, the book aims to explore whether a form of national
standards could have a role to play in the development of this advocacy
culture, and the ways in which advocacy practice may be strengthened
by training and other forms of support for advocates.
Both authors of this book work for advocacy organisations and
have (hopefully) absorbed a range of perspectives on advocacy over
the years. These work commitments mean that it has not been possible
to undertake extensive fieldwork or widespread consultation during
the preparation of this book. The present work is above all a book of
ideas. Indeed, one of its key themes is the extent to which advocacy
is driven by deeply held values and principles. Making sense of
advocacy means gaining a clearer picture of these ideas. It is hoped
that the books conclusions will help to carry forward the debates
about funding, evaluation and standards in advocacy; but even more
importantly that it will help whoever has an interest in advocacy
service users, advocates, funders or policy makers to reflect on
advocacy in their locality, and to contribute to its development.
This is not a book about self-advocacy. It seeks to describe what
happens when one person speaks up for, or identifies with, another.
However, it may well be that some of the themes presented in this
book are familiar to self-advocates; in particular, it is hoped that the
outlines of an advocacy culture set out in Chapter Five will be
recognisable and useful to them.
Except where indicated otherwise, the stories used to illustrate
ideas in the text are invented; that is, they draw on a range of situations
which the authors have witnessed or have heard told, but they are
not intended to be the stories of real people. In part, this approach
reflects the lack of time available for collecting true stories; but it also
reflects the concerns for confidentiality stated above. Readers wishing
to study accounts of real advocacy partnerships are referred to the
inspirational text Standing by me (Williams, 1998).
Throughout this work, reference is made to care services,service
workers and the service culture. A major theme of the book is the
way in which the interests of care services may conflict with those of
their users. It is also suggested that there are significant tensions
between the service culture as represented by the Best Value initiative,


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and genuinely independent advocacy. None of this should be taken

as implying a pejorative view of community care or health services as
such. The authors are aware of many services that are genuine and
consistent in their commitment to user empowerment; and of many
service workers who show tirelessness and skill in pursuit of their
clients interests. It is just as important that advocacy reinforces the
efforts of these services and workers as that it challenges poor structures
and practices.
A word should be said regarding some of the terms used in this
book. For the sake of clarity and consistency, a single set of terms has
been used, even though these terms are by no means agreed across
the advocacy movement. Advocacy organisations are throughout
referred to as schemes rather than services, for reasons which should
become apparent as the reader progresses. People who are supported
by advocates are generally termed partners rather than users or
clients. The term partner is widely used in citizen advocacy schemes,
but much less so in professional advocacy circles where the whole
concept of partnership may seem inapplicable. There were no strong
grounds for using partner as opposed to the other terms; we chose it
simply because it is unique to the advocacy movement, whereas client
and user have wider usage. Different kinds of advocacy (such as
volunteer advocacy, professional advocacy) are referred to as forms.



What is advocacy?

There may be times in all our lives when, for whatever reason, we feel
unable to assert ourselves in a given situation. For example, if a waiter
in a restaurant delivers the wrong meal or the food arrives lukewarm,
we may be reluctant to complain for fear of causing a fuss, and instead
allow our (less reticent) dining companion to do so on our behalf. Is
this advocacy? If it is, then it can be argued that we can all benefit
from advocacy support and can all be advocates for those close to us,
given the right set of circumstances.
We can all put up with cold food from time to time, but what if
the problem is more serious? Suppose a loved one is critically ill in
hospital, and it has been suggested that their life-support machine be
switched off? The patient cannot make their wishes known, at a time
when their vital interests are threatened. The doctors involved will
claim to have the patients best interests at heart, but what if there are
another three patients with a better chance of recovery waiting for
the intensive care bed? In wanting the best for these patients also, the
doctors have a conflict of interests. All sorts of questions might go
through our minds in this situation. Do the doctors realise how
precious this person is? Have they really done all that can be done?
Are they sure of their diagnosis? We might articulate some or all of
these questions, prompted by a sense that the patient deserves no less.
In doing so, we are acting as their advocate.
Advocacy can be described as the process of identifying with and
representing a persons views and concerns, in order to secure enhanced
rights and entitlements, undertaken by someone who has little or no
conflict of interest. Put more positively, advocacy is rooted in a special,
and perhaps unique, relationship between the advocate and the person
they support and uses the tools of representation, negotiation and
persuasion in order to bring about a beneficial change in the partners
life. Advocacy requires a commitment to the partner (the term that
will be used throughout this book for the person supported by an
advocate) but also a determination to see the process through to

A right result?

aim for something better at the end of the process, either a concrete
victory (such as a change of residential home or a new social worker),
or a greater sense of involvement and empowerment. This book
aims to reflect on the processes and presuppositions that are involved
when one person speaks up for another, and the ways in which
advocacy organisations in the UK have codified these processes. It
will reflect on the main strengths and weaknesses of advocacy, and
suggest ways in which the advocacy movement could develop.
The need for advocacy arises where circumstances have taken away
an individuals ability to speak up freely for their interests. The advocacy
movement has at its foundations the recognition that there are groups
of people for whom such radical disempowerment is not so much a
random occurrence as a way of life. This book will study the particular
forms of advocacy which have at their core the active representation
of the views and interests of people who are at significant risk of
social exclusion or misrepresentation. The main forms of advocacy
can be introduced as follows.

Citizen advocacy
The real roots of contemporary advocacy can be traced to the United
States and attempts to address the fears and anxieties of carers and
families of disabled people. The opening statement of the seminal
British text Citizen advocacy: A powerful partnership (Butler et al, 1988)
accurately summarises the birth of the citizen advocacy movement:
... in 1966, delegates at a conference in the United States, concerned
with cerebral palsy, looked at the question What will happen to
my child when Im gone? They decided that one answer might
be that when there is no family, willing or able, to protect a persons
interests, those interests could continue to be protected by a citizen
advocate, an unpaid citizen who has no connection with the
service provided to that person, thus avoiding any conflict of
interest. (Butler et al, 1988, p 3)

With the identification of vulnerable groups and of social and service

structures whose interests may always conflict with those of the
individual, came the inspiration for organised advocacy. The concept
was seized upon and developed by people concerned with issues of
r ights and protection for vulnerable people, notably Wolf

What is advocacy?

Wolfensberger (and his collaborators) and John OBr ien.

Wolfensberger in particular can be credited with defining and
promoting a set of guiding principles for the emerging citizen advocacy
movement that continue to predominate. His model was based on a
long-term, one-to-one relationship between the advocate (who should
be an independent, unpaid and valued member of the local
community) and their partner or protg. The primary role of the
citizen advocate was to promote and where necessary represent, the
interests and wishes of their partner. Although citizen advocates would
be recruited, matched and supported by their local scheme, their
primary loyalty would be to their partner.
Citizen advocacy philosophy can be seen to be guided by a number
of assumptions about society and about those service systems that are
designed to care for and support vulnerable people. The first of these
is that certain groups of people are at great risk of exclusion and illtreatment, not only from society at large, but also from the very service
systems which are designed to care for them. These groups could
include (but are not limited to) older people; people with mental
health problems; people with learning disabilities; people with physical
and sensory disabilities; people living with HIV and AIDS; homeless
people; people with drug or alcohol problems; and children with
special needs or looked after. To a large extent, the history of care
for such groups of people is a history of institutionalisation, abuse and
neglect. While there has been a great deal of progress in relation to
the shift away from large, Victorian hospitals towards communitybased alternatives, these new services, although based in the community,
are often not part of the community. To this extent Wolfensbergers
perceptions of exclusion and potential abuse still seem valid. There
are many instances where current statutory powers have proved
inadequate to protect service users. Where such powers do exist, the
interests of the public (for example, the drive to maintain low income
tax rates) may not coincide with the interests of those who require
state support as a result of age, disability or poverty.
The second key assumption is that there are people who care
enough about the situation described above to voluntarily give up
their time to do something about it. In essence, this is what makes
citizen advocacy unique and is one of its key selling points.
Wolfensbergers assertion was that ordinary US citizens could and
should give a commitment to engaging in mutually beneficial
relationships with people who were at risk of social exclusion or
worse, in a spirit of community integration. To the extent that citizen

A right result?

advocacy schemes based on Wolfensbergers vision have proliferated

both in the US and across the globe, then he could be said to have
guessed right. However, the concept of the valued citizen as a central
tenet of citizen advocacy philosophy remains as contentious now as it
ever was three decades ago. Essentially, the debate hinges on whether
it is possible to define a persons value as a constant, unchanging
attribute or whether it is in fact, specific only to particular situations
and environments. Features such as race, gender, religion and social
class can all have a bearing on an individuals standing and credibility,
but they do not in themselves define value or status. Many of
Wolfensbergers critics have argued that his benchmark for the valued
citizen is the white, middle-class male (see, for example, Chappell,
1992). Although Wolfensberger himself has vigorously denied this,
the legacy of such an indictment lives on. Many contemporary UK
citizen advocacy schemes have substituted the phrase valued citizen
with the less contentious ordinary person in order to counter the
supposition that some citizens are inherently more suitable to become
advocates than others.
Citizen advocacy: key features
Advocates are unpaid members of the local community
Long-term, one-to-one relationship
Schemes actively seek out individuals who may benefit from a citizen
advocacy relationship
Advocacy scheme matches advocate and partner
Advocate is accountable principally to their partner
Schemes are structurally independent from service agencies

Citizen advocacy continues to be influential in the UK, with dozens

of schemes subscribing to many if not all of the principles outlined
by Wolfensberger. Although there are citizen advocacy schemes
supporting older people and those with mental health problems, the
largest number of schemes create partnerships with people who have
learning disabilities. The long-term nature of citizen advocacy
partnerships offers the potential for developing self-confidence and
opportunities with those who may have experienced exclusion and
institutionalisation over many years. In particular, citizen advocacy

What is advocacy?

more than any other advocacy form allows for the active identification
of those individuals who may benefit from an advocacy relationship
even if they are not able to refer themselves to a scheme. Citizen
advocacy principles assert that many people who might gain most
from such a partnership are those who are least likely to put themselves
forward (the least vocal, least visible, most vulnerable members of
society). Some citizen advocacy schemes adopt a policy of assertive
outreach within service systems, paying regular visits to settings such
as day centres, residential homes and hospital wards to identify potential
partners and make them aware of the scheme. At best, such an assertive
approach represents a significant step towards the social inclusion of
the most isolated members of the community. However, this needs
to be tempered with a respect for privacy and confidentiality and an
understanding that some individuals will choose not to engage with
citizen advocacy schemes or advocates at all.
Citizen advocacy principles allow for the recruitment of a small
number of short-term or crisis advocates within schemes. Such
advocates help individuals to resolve a given problem, and then
withdraw, rather than offering the ongoing support typical of citizen
advocacy. Given the difficulties which many people experience in
accessing community care and other entitlements, it is not surprising
that this form of advocacy has taken on a life of its own. Throughout
the book, we have referred to it as volunteer advocacy.

Volunteer advocacy
Volunteer advocacy schemes share with their citizen advocacy
counterparts the belief that the unpaid status of the advocate is of
primary importance. Advocates speak up for their partners out of
commitment to them, and not for remuneration. However, such
schemes are likely to take a pragmatic approach to the paying of
volunteer expenses, whereas most citizen advocacy schemes would
view even this as diluting the advocates loyalty to the partner.
Volunteer advocacy schemes are more likely to be generic than
citizen advocacy ones; that is, they will work with a range of partners
who may be disabled, elderly, or mental health users, or who may not
identify with any particular group. Because the advocacy is issuesbased, the advocates support a number of advocacy partners. Whereas
the match between advocate and partner is likely to be the
determining factor in the success or failure of a citizen advocacy

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partnership, volunteer advocacy will depend as much on the

knowledge and skill of the advocate as on their relationship with the
partner. Training and supervision of advocates are therefore likely to
be prominent features of volunteer advocacy schemes.
Volunteer advocacy: key features
Advocates give their time freely although they may receive out-ofpocket expenses
Partnerships focus on resolving specific issues rather than on longterm support
Advocates may support more than one partner at a time
Schemes are likely to support a range of user groups

The growth of citizen advocacy and other forms of third-party
advocacy schemes has coincided with the development of a
burgeoning self-advocacy movement and the establishment of userled organisations such as Survivors Speak Out (mental health user
network) and People First (self-advocacy groups of people with
learning disabilities). There are now a large number of local, regional
and national user organisations which share the common objectives
of empowerment, pride and social justice. Most of these are organised
around a specific issue or client group although some are broad-based
coalitions of groups and individuals. Although such groups may have
shared aims and aspirations, they differ widely in their choice of
methods by which to achieve them. These range from information
and mutual support to political lobbying and direct action. User
groups may also engage in awareness-raising and training activities as
well as supporting group members to learn new skills and develop
Self-advocacy has been perhaps the predominant form of advocacy
adopted by (physically) disabled people. Local coalitions of disabled
people, often affiliated to the British Council of Organisations of
Disabled People (BCODP), have vigorously asserted their members
equality and right to independence. These groups have at times voiced
criticism of citizen and other forms of advocacy on the grounds that

What is advocacy?

they may perpetuate perceptions of the essential dependency of

disabled people.
Self-advocacy: key features
Organised and driven by disabled people or service users
Self-advocacy groups offer mutual support and confidence building
Individuals working together to challenge stereotypes and
Operating at local and national level
Sharing information, knowledge and experience

Peer advocacy
The term peer advocacy is used to describe advocacy relationships
in which both the advocate and their partner share a common
experience or environment, for example, two residents in a nursing
home, two patients in a general practice, or two women with personal
experience of domestic violence. Although peer advocacy is not in
itself a discrete advocacy form in the same way as, say, citizen advocacy,
it can nevertheless provide a powerful force for both challenge and
change within service settings. Peer advocacy refers primarily to who
does the advocacy, rather than how it is done. Peer advocates (whose
primary qualification is their own personal experience of disability,
service usage or dis/empowerment) may engage in a one-to-one
relationship; have a caseload of clients; or support a self-advocacy
group. There are a small number of specific peer advocacy schemes
in the UK (for example the Peer Advocacy Project at the Maudsley
Hospital, London) but the model of advocacy practised by such
schemes is not clearly defined. Often, peer advocacy occurs in an
informal and often impromptu way within service settings such as
day centres, residential homes and hospital wards.

A right result?

Ethel is waiting to see her GP. As she sits in the waiting room, she
notices that the elderly woman sitting beside her is becoming more
and more distressed. Ethel decides to intervene:
Are you alright, dear?
Not really, Ive been waiting for ages and Im not feeling too good.
How long have you been waiting exactly?
Two hours. I think theyve forgotten about me but I dont want to
make a fuss.
Two hours? Thats outrageous! Why dont you let me have a word
with the receptionist, just to check how much longer you have to
wait? Its no trouble.
Ethel speaks to the receptionist on her peers behalf and argues for
her to be given priority in the queue.

As well as being a genuine act of human kindness and solidarity, the

actions of Ethel in the vignette above are also inherently political, in
that they provide a challenge to widely-held beliefs that only those
with high status within society are able to effect change. At one level,
Ethel is as disempowered as her frustrated peer she too is elderly, a
patient, stuck in an inhospitable doctors waiting room but for
whatever reason, she feels both willing and able to intervene. Given
another set of circumstances, it may be Ethel herself who benefits
from her peers intervention, and in time both parties may come to
enjoy a fruitful and mutually beneficial relationship.
Peer advocacy: key features
Advocate and partner share common experiences or environments
Relationship often based on mutual support and empowerment
Peer advocacy may be one-to-one or casework-based
Few established peer advocacy schemes
Peer advocates challenge power dynamics of giver and receiver

What is advocacy?

Professional casework advocacy

In the field of mental health, especially within the psychiatric hospital
system with its emphasis on compulsion and detention, an alternative
form of advocacy was found in the Dutch patients advocate approach.
This introduced the concept of the advocate as paid worker, with a
caseload of clients who sought support with a range of issues (see,
for example, Klijnsma, 1993). In recent years this form has been
imported into the community, and not only in a mental health context
the most rapid growth in advocacy has been in such professional
casework schemes covering a wide range of client groups. There may
be a number of reasons for this, including: the general decline in the
number of volunteers coupled with an increase in the range of
voluntary work opportunities; the crisis nature of many peoples
problems; and the potential for a professional casework advocacy
scheme to support larger numbers of people than its citizen advocacy
counterpart. This latter point may make such a scheme more attractive
to funding bodies who feel it will give them more advocacy for their
money. Statutory funding agencies may also believe that a professional
casework scheme can be more accountable or even more professional
in its approach although there is little empirical evidence to support
this claim. However, such a close alliance with the statutory sector
certainly increases the potential for a conflict of interest to arise.
Although paid advocates may have a better knowledge of local services
and systems (as they are working within them on a daily basis) there
is a greater danger of collusion with service agencies and the threat of
withdrawal of funding if the advocate behaves in ways which offend
the statutory services.
It is within professional casework advocacy schemes that the impetus
for more consistent standards, accreditation and regulation is most
strongly felt and articulated. To the extent that relatively high levels
of public resources are being targeted towards this type of advocacy,
such a focus may be appropriate, but there is a danger that the drive
for greater accountability will lead to the imposition of traditional
service measures which value quantity over quality. At its best,
professional casework advocacy combines a values-driven focus on
relationships, empathy and solidarity with a high level of expertise in
and knowledge of local service systems and how to effect change on
behalf of individuals within those systems. Although casework
advocacy does not have the same emphasis on long-term, one-toone relationships as citizen advocacy, it does have a crucial role to

A right result?

play in ensuring that peoples rights and entitlements are safeguarded

on a day-to-day basis.
Professional casework advocacy: key features
Advocates are generally paid workers
Each advocate has a caseload of people they support
Advocacy is task-based, with clear outcomes and targets
Advocate/partner relationships are usually short-term in nature
Advocates work in a team

Legal advocacy
Legal advocacy is best seen as a separate but complementary form of
advocacy to those described elsewhere in this chapter. In this context
the term legal advocacy is used to refer to the work done by lawyers
on behalf of users of health and social care services (in the form of
litigation and judicial reviews) and those investigations carried out by
quasi-legal bodies such as ombudsmen. The relevance for this chapter
is that advocacy schemes often refer complex cases or those where
there is believed to be a legal precedent, to law centres, legal practices
or, in the case of complaints, to the relevant ombudsman (there are
ombudsmen for the NHS, local authorities and the independent
housing sector).
In a legal context, advocacy can be seen to mean representing or
pleading a case on behalf of an individual. In order for this
representation to be effective, there needs to be some degree of legal
precedent, that is, an existing law applies or a new law needs to be
made on the strength of a particular case. Examples of this include
challenging a local authoritys duty of care, contesting the imposition
of a Mental Health Act section or suing for medical negligence. But
the term advocacy is used to describe the particular activity of lawyers
and other legal professionals rather than in the cultural context applied
elsewhere in this book. Legal advocacy is different to other advocacy
forms in a number of very important respects.
It is common for advocacy schemes to develop relationships with
lawyers or law practices specialising in particular issues such as mental


What is advocacy?

health or housing. Many schemes have lawyers on the management

committee as a means of obtaining legal expertise within the scheme.
Conversely, many solicitors firms have close links with local lay
advocacy schemes and refer on to them if a case is unlikely to be
successful in a court of law. This is especially relevant in the context
of community care where so much of what happens is governed not
by laws, but by local policies and procedures. However, Bateman
(2000) insists that:
While some advocacy can be performed successfully using good
negotiation skills, without relying on the law or other rules, it is
not advisable, and it is important to establish whether there is a
legal basis to a case before commencing negotiations or any other
active advocacy. (Bateman, 2000, p 138)

This may well be overstating the case for legal intervention. Lay
advocates (a legal term to describe non-legal advocacy) have the added
advantage of being better able to develop longer-term relationships
with partners that are not exclusively outcome-focused and may
ultimately prove more rewarding to both advocate and partner. There
is also the issue of cost taking a case through the courts can be an
extremely expensive business, and changes to legal aid structures have
made it much more difficult for individuals to obtain financial assistance
in fighting their case. Even Bateman himself goes on to state that
people often
... require skilled, appropriate legal help. Despite this, there are
many instances where the client does not have access to skilled,
appropriate legal help. (Bateman, 2000, p 138)

Brandon (1995) is more critical of the legal profession, especially in

relation to people with disabilities. He suggests that, through lawyers
self-appointed expert status and desire for profit, they reproduce many
of the power imbalances that already exist in the wider society. He
goes on to argue that:
The movement from domination by care professionals to
domination by lawyers can consist in simply swapping one form
of tyranny for another. (Brandon, 1995, p 18)


A right result?

According to Bateman (2000, ch 11) there are six stages to advocacy

in a legal context: presentation; information-gathering; legal research;
interpretation and feedback; active negotiation and advocacy; and
litigation. It is telling to note that at no point during this process is
the advocate required to develop anything other than a cursory
relationship with their client they are entirely focused on obtaining
an outcome based on the facts of the case. In this way, it is unlikely
that the person on the receiving end of the legal advocates intervention
will have any opportunity to represent themselves (self-advocacy),
learn new skills or even gain new experience.
Legal advocacy: key features
Legal advocacy

Lay advocacy

Professional service model

Variety of advocacy forms

Lawyers as experts

Advocates as knowledgeable allies

Based on legal precedence

Based on rights, choice and justice


Process- and outcome-focused

Service often fee-based

Free to partners

What has advocacy achieved in the UK?

Spend a day with almost any established advocacy scheme in the UK
and you are likely to come away with a sense of something new and
exciting going on. Whatever hard evidence there may or may not be
for outcomes (and of this more later) the advocacy movement as a
whole sustains levels of enthusiasm and commitment found in few
other fields of social endeavour. Hearing anecdotes from schemes,
one is struck again and again by the twin themes of the recovery of
human dignity and the lifting of social censorship challenging those
attitudes and structures which impose a kind of silence on the
individual. Twenty years into the history of the UK advocacy
movement, these themes show no sign of exhaustion; on the contrary,
they seem to reflect and may even have shaped (if the main political
parties are to be believed) a political culture which aspires to the
dismantling of all barriers to individual opportunity.
Nor is this sense of conviction limited to the advocacy movement


What is advocacy?

itself. Advocacy enjoys generally high repute among social services

and NHS providers. Advocacy has both shaped and benefited from
the culture of care in the community, which at least purports to
promote choice and user-centredness. The restrictive professional
practices of the hospital era, by which medical staff could define a
patients interests without fear of challenge, have waned considerably.
The right to advocacy is stated in many local Community Care
Charters (although perhaps without guarantee that a local scheme
exists to provide it) and good practice guidelines at both national and
local level extol the virtue of an advocates involvement. When service
workers are critical of advocacy, it is generally of a particular schemes
failure to live up to its ideals not of the ideal itself.
With dynamism and respect has come growth. In 20 years, literally
hundreds of schemes have developed across the UK. There has been
continued innovation and adaptation: the citizen advocacy form has
been successfully applied in both urban and rural settings, and has
supported people of all ages and from a range of minority ethnic
groups. Equally, alternative models such as self, peer or casework
advocacy have evolved according to local needs and ideas. In particular,
these last-named models of advocacy have been taken up as part of
wider actions for social change. Many social campaign groups now
include individual advocacy among their programmes of action.

What has the UK advocacy movement failed to

We have so far spoken of the advocacy movement as though the
existence of this were an established fact. On closer inspection, this
turns out to be far from certain. Ask the question What is advocacy?
of five advocacy schemes, and their five answers may have little in
common. For a start, there are very diverse forms of advocacy each
operating to principles that are not only different, but may appear
contradictory. For example, citizen advocacy schemes champion the
idea of the untrained advocate, the ordinary citizen who is
uncontaminated by service perspectives; casework advocate schemes
will tend to emphasise the importance of knowing the system well,
so as to champion the user whose rights are threatened by it. Some
groups will see advocacy as an activity which must be kept distinct,
whereas for others it may be part of a wider movement for social
change, blending with other features such as advice, information-


A right result?

giving or befriending. Even among advocacy groups of the same

type, there may be strong disagreements about, for example, the precise
extent of users confidentiality, or whether or not volunteer advocates
should receive expenses.
So, for all the movements dynamism, advocacy lacks a clear identity.
This is reflected in the fact that while service providers in many
instances accord advocacy a high status, it is barely recognised, let
alone understood by most members of the public. The term advocacy
itself sounds awkward and specialist no great help if one is really
trying to convey the message that most members of the community
may both need advocacy and be advocates themselves at one time or
another in their lives.
Not surprisingly, this lack of identity has undermined most attempts
to formulate and develop good practice across advocacy schemes.
The organisation Citizen Advocacy Information and Training (CAIT)
has long been the national resource for citizen advocacy schemes.
Over the past 15 years, it has promoted a set of principles and a Code
of Practice which define citizen advocacy, and has supported
coordinators forums at which practice issues can be shared. Much
good work has been done here, but it is a fact that a significant (and
perhaps growing) number of schemes do not wish to follow the citizen
advocacy model. Similarly, the United Kingdom Advocacy Network
(UKAN) has done substantial work with mental health user groups,
and has also produced a Code of Practice for advocates (UKAN,
1997); but this too is specific to one form of advocacy. Thus at the
regional level, one finds a series of forums (for example Advocacy
Across London,Wessex Advocacy Consortium) which represent the
many different kinds of schemes. However, what these bodies gain in
inclusivity, they tend to lose in political force; they are unable to lay
down local standards for advocacy, or to issue authoritative guidelines
to purchasers, precisely because they embody such diversity.
There is, then, a lack of coherence in the advocacy movement; on
the one hand no national body commands the widespread assent
required for its code and principles to become standard; on the other,
regional forums lack the unanimity to develop such standards for
their own members. Whether the new National Citizen Advocacy
Network envisaged by the government (DoH, 2001) can resolve this
paradox remains to be seen.
With this lack of coherence comes a still more worrying lack of
consistency. If advocacy is known for its dynamism and strong values
base, it also has a reputation for variability in its success rate:


What is advocacy?

In another instance, his advocate was having such a detrimental

effect on Bob that Bobs brother asked that the advocate be
removed. The care manager had to become involved and scrutinise
the quality of the advocacy service being provided. Subsequently
the advocacy group apologised for the advocate, and he was
withdrawn. (Christina Wiggin, presentation to BILD Citizen
Advocacy Conference, London, March 2000)

In this instance, something clearly was wrong with the advocate; but
there have been many other instances where family members have
asked that the advocate be removed for all the wrong reasons. For
example, the advocate may be trying to help the partner to assert
their right to control their own finances in the face of opposition
from family members who are either over-protective or (sadly, as
sometimes happens) using the money for their own purposes. What
criteria exist to distinguish good from bad advocacy, and who applies
them? Though social services seem to have assumed this judicial
role in the anecdote about Bob, above, they can hardly be allowed to
sit in permanent judgement of schemes that are, often, challenging
There are a couple of models of evaluation current within the
citizen advocacy movement, but these have no formal status; at best,
they constitute a form of peer review. For the wider advocacy
movement, there seem to be no agreed benchmarks for performance
whatsoever. This has in recent years led to a tendency for purchasers
of advocacy (primarily health and social services) to impose their
own monitoring regimes on local advocacy schemes. We shall argue
that this threatens to turn advocacy into a numbers game, while
yielding little useful information about its value and favouring
quantitative rather than qualitative outcome measures.
Government initiatives will undoubtedly develop the statutory basis
of advocacy over the next few years. But what sort of advocacy will
this be? The various forms of advocacy described in this chapter are
all dynamic and influential; but they are also typically delivered by
schemes which are informal, diverse, and locally-based. Is there a
danger that with statutory recognition there may come a demand for
the standardisation of advocacy which will threaten its key principles
and vitality? The authors of this work believe that just such a threat
does exist, but that it can be averted by clear thinking and common
action on the part of advocacy organisations.
Advocacy is an act of solidarity between two people. It is a political


A right result?

act with consequences for both individuals and the community as a

whole, challenging inequality, opposing racism, preventing abuse, or
even introducing someone to a new opportunity or social setting
all constituting steps towards a more civil and just society. But planning,
implementing and supporting advocacy is not straightforward. The
next chapter will highlight some of the difficulties that beset advocacy



Issues in contemporary advocacy

In Chapter One we described the history and development of the

UK advocacy movement, from its origins in the US citizen advocacy
doctrine through to contemporary forms of casework, peer and
generic advocacy provision. This rapid expansion in the number and
type of local schemes has undoubtedly meant that many more people
have benefited from advocacy support than would otherwise have
done so. Within the context of diminishing resources and increased
need for primary health and social care services, this can only be a
good thing. Advocacy plays a key role in ensuring that peoples voices
are heard, their views heeded and acted on. It can be argued that as
a direct result of the intervention of advocates, a great many more
people have access to the types of care and support they need to live
full and active lives. Advocates have secured extra resources, battled
against institutionalisation, challenged bad practice and pioneered
acceptance and tolerance. Above all, advocates have championed the
cause of the individual within a system that seems to be predisposed
towards categorisation and depersonalisation.
Although there is much to justify the celebration of these
achievements, there remain a number of fundamental dilemmas for
the advocacy movement that, if not addressed, may pose a very real
threat to its continued progress. In attempting to define these
dilemmas, we accept that there will be a range of views about the
relative priority of such issues. Nonetheless, we hope that by naming
the problems, by stimulating debate both within the movement and
with those individuals and agencies affected by advocacy, real solutions
can begin to be developed.
Advocacy in the UK has developed rapidly in the last 20 years. It
is not surprising that most energy should have been expended on
defining the principles which make each form of advocacy distinct,
and on building local schemes which enshrine these principles.
However, this emphasis on ideology and local action could lead to
advocacy becoming essentially inward looking if it is not balanced by


A right result?

broader perspectives. There is a need to identify, develop and share

good practice if advocacy is to have a strong national profile. More
pressing still, there is a need to recognise the common threats facing
advocacy schemes, to understand their implications, and to agree
Six issues in particular present difficulties for contemporary
Problems for UK advocacy schemes
The need for secure funding
Maintaining real independence in advocacy
Ensuring equity and a diverse spectrum of advocacy arrangements for
a multicultural society
Defining and promoting loyalty to the partner
Minimising risk to both advocates and partners
Demonstrating effectiveness and accountability (via regulation, evaluation
and training) without compromising principles

Each of these issues deserves to be examined in greater detail.

It is fair to say that the majority of advocacy schemes in this country
are still dependent on the statutory sector funding available primarily
via health authorities and social services departments. Although this
financial support is welcome and serves to provide stability and security
to local advocacy projects, there are inherent dangers in relying too
heavily on such funding. Primarily, these centre on the potential for
a conflict of interest to arise when advocacy services attempt to assert
their independence on behalf of local service users. Advocates often
find themselves in the unenviable position of biting the hand that
feeds them, for example when advocating for users whose services
have been cut or reduced by the funding authority. There is also a
danger of losing credibility with potential users of the advocacy scheme
as a result of not being truly independent. How can users trust the
schemes promise of confidentiality and loyalty if it is funded by the


Issues in contemporary advocacy

very bodies that have failed them? It is incumbent on advocacy

projects to develop positive strategies for combating these dilemmas,
such as the negotiation of contracts that ensure autonomy can be
safeguarded even when relations between the two parties become
strained. It is perfectly feasible that such schemes can be funded on
the explicit understanding that the advocacy role can be adversarial
even though partnership working is preferential. In many areas codes
of practice have been jointly developed between funding bodies and
advocacy schemes which detail how advocacy support is to be
provided, to which client groups and by which methods. The following
is an extract from a Statement of operational principles developed
by Advocacy Partners:
An advocate as a free and independent agent shall determine his/
her own actions in relation to the needs of his/her partner. Neither
a service agency nor the Citizen Advocacy office can order an
advocate how to act on behalf of the partner whom he/she
represents. (quoted in Wertheimer, 1998, p 90)

While advocacy codes of practice can offer some safeguards against

bad practice and serve to clarify the respective duties of both parties,
it is essential that they are not dictatorial to the extent of stifling
creativity. The desired outcomes, and the processes adopted to achieve
them, should remain within the control of the advocate/partner
In recent years many large regional and national charities have set
their sights on advocacy provision. For these organisations, advocacy
is only one small aspect of a much larger portfolio which may include
direct service provision. In many areas, such corporate schemes are
now in the majority, especially where the funding agencies have insisted
on a competitive tendering process that favours those organisations
familiar with such business practices. Few local schemes have the
infrastructure necessary to compete in such an arena, even though
they may have the advantages of local knowledge and support from
local users and service agencies. Nor is competitive tendering the
only way in which the contract culture has affected advocacy provision.
Statutory funders increasingly demand evidence of value for money
or Best Value. This raises again the question what is good advocacy?
Ironically, the advocacy scheme may also find itself competing with
service provider agencies for scarce resources at a local level. The
proportion of those resources that are allocated to each activity will


A right result?

probably depend as much on politics as it does on need. For funding

bodies, especially the key agencies of health and social services, the
decision to fund advocacy is driven by a reluctant acknowledgement
of the existence of deficiencies in service provision. Put another way,
advocacy services exist and are funded to point out the gaps in services,
in order that commissioners and service planners may address them.
In a system as complex and multifaceted as community care, there
will always be people who slip through the net. Experience shows
that more often than not, the victims of this anomaly are those
individuals and groups of people who are similarly disadvantaged in
other arenas of public life: women, black and minority ethnic
communities, gay men and lesbians. Even within service systems
devised specifically to support frail and vulnerable people, such
inequalities can be found in both the commissioning and provision
of care. By targeting resources towards advocacy, statutory agencies
are opening themselves up to challenge and scrutiny of both their
philosophy and practice (although the extent to which this is legislation
driven rather than undertaken voluntarily is open to question).
Advocates for disadvantaged people will eagerly take issue with service
providers on their clients behalf, ensuring users views and concerns
are taken up and acted on by the relevant personnel. In so doing,
advocates are operating within a political context, challenging the
status quo and providing a force for change; thus there is an inherent
potential for conflict between independent advocacy and statutory
Salvation from such dilemmas can come in the form of nonstatutory, independent funding such as that available via the many
charitable trusts (and, of course, the National Lottery) which provide
resources to voluntary organisations. But even these have their own
problems such as the short-term nature of funding, usually up to a
maximum of three years, and the need to make the project comply
with funders particular criteria. Trusts will not always be fully appraised
of the need for advocacy or how best to support its development.
When funding does run out, schemes are often faced with the
unenviable task of ending advocacy relationships or leaving them
unsupported. Although continuation funding can sometimes be
forthcoming, many statutory bodies are reluctant to offer resources
to schemes previously funded by grant-making trusts and vice versa.
Hence, the reality for the majority of advocacy schemes is that longterm funding is far from secure.
Traditional citizen advocacy schemes, following Wolfensberger, have


Issues in contemporary advocacy

pursued multi-source funding as a solution to this problem. This

means having a wide range of funding sources which may include
the statutory sector, charitable trusts, private sector sponsorship or
assistance in kind, and income generation from activities such as
training and consultancy. One downside to such an approach is that
the amount of administrative resources needed increases
proportionately with the number of contributors. There may be a
need for a fundraising post to be created as well as additional
bookkeeping and financial control procedures. There may also be
different monitoring requirements for each funding body. For
example, social services departments may require hard measures such
as number of clients seen, length of interventions and so on, whereas
charitable donors may be more concerned with quality of life indices.
The more an advocacy scheme must build capacity to deal with
these demands, the greater the likelihood of tension between
bureaucratic structures on the one hand, and user-centredness on the
The potential for direct government funding for advocacy is an
issue of ongoing debate. The 1986 Disabled Persons (Services,
Consultation and Representation) Act first raised the possibility of
legislative recognition of the need for independent advocacy and for
this to be funded centrally. The original intention was for disabled
people to be given the legal right to an advocate when required.
Although this key section of the Act was not implemented by the
then Conservative government, the campaign for legal recognition
of advocacy began in earnest. While the value of advocacy was noted
in subsequent legislation, such as the 1990 National Health Service
and Community Care Act, state involvement in the funding and
development of a comprehensive programme of advocacy provision
was not forthcoming. The issue has been raised again in the context
of the government review of the 1983 Mental Health Act, with mental
health advocacy schemes across the country instrumental in lobbying
for access to independent advocates to be made a statutory right.
Most recently, the learning disabilities White Paper Valuing people:
A new strategy for learning disability for the 21st century (DoH, 2001)
has at least conceded the principle of central government funding
for advocacy. The White Paper commits the government to the
twin aims of setting up a National Citizen Advocacy Network
and ensuring that there is resourcing for a citizen advocacy scheme
in every local authority area. The medium-term future of advocacy


A right result?

will to a considerable extent hinge on the success or failure of these

In a general health context, the recent announcement in the NHS
Plan (DoH, 2000) that the government intends to introduce a network
of Patients Advocacy and Liaison Schemes (PALS), has sent shock
waves through an understandably cynical advocacy movement.
Although the development of PALS will present opportunities for
the advocacy movement both in terms of recognition that advocacy
is a force for good, and as a possible source of funding, there seems a
real danger that PALS will be advocacy in name only. The very fact
that advocacy is used in conjunction with the concept of liaison
suggests that PALS may be as much about the needs of the system as
of individual patients. More will be said of this later.

Project and advocate independence is crucial for a number of key
reasons. Advocacy is about being loyal or partial (as opposed to
impartial) to the people advocated for, hence the first line of
accountability is justifiably to service users. Often, users come to
advocacy schemes as a last resort, after their own efforts to resolve
issues and problems have failed and for many potential users, even
approaching the scheme is in itself a huge achievement. Indeed, some
advocacy schemes, particularly citizen advocacy schemes, are proactive
in offering advocacy to individuals for this very reason; they may lack
the confidence to ask for support. It is an indictment of our current
system that many individuals will have developed a deep sense of
mistrust of conventional services as a result of previous bad experiences.
At its most extreme, many within service systems (particularly those
who have experienced a lifetime of institutionalisation or care) have
encountered real abuse and neglect at the hands of those who were
supposed to protect them. There is no shortage of examples of
vulnerable people being sexually, emotionally, physically and financially
abused in service settings such as childrens homes, psychiatric hospitals
and residential care homes. In order for the advocacy scheme to
truly represent these users views it needs to be free from conflict of
interest, able to promise loyalty to users without compromise and
strong enough to challenge authority on behalf of individuals.
There are a whole range of ways in which independence impacts
on both the design and implementation of advocacy programmes.


Issues in contemporary advocacy

These include organisational structure; ownership of the scheme and

its work; selection, training and support of advocates.

Organisational structure and ownership

Many advocacy schemes are independently managed, either as
registered charities or companies limited by guarantee (or both), with
their own, independently elected management committees comprising
interested and skilled local people. This is the ideal model as it promotes
autonomy and safeguards the schemes principles from corruption or
outside influence. However, it can also be the most difficult to achieve
and sustain. Recruiting enthusiastic and committed volunteers to act
as trustees for the agency can be extremely difficult, especially given
that advocacy must compete with more well-known causes such as
care of older people or childrens services. Advocacy as a concept is
still not well understood by the general public and hence those people
who may be interested in joining a management committee may not
be aware of the existence of local advocacy schemes or may be hesitant
about getting involved in an activity about which they have little
knowledge. However, once such schemes are established they are
often very popular with users, who perceive them as truly independent
and best able to fight their cause without fear of compromise.
Involving users in the day-to-day running and management of the
scheme may further enhance independence. In this way, users are
not just on the receiving end of the advocacy process, they are also
directing its implementation.
Not all advocacy schemes enjoy such independence, however. Some
other schemes are less structurally independent, being run as projects
within larger voluntary organisations such as the National
Schizophrenia Fellowship, MENCAP and Age Concern. Others still
are managed by local infrastructure organisations such as Councils
for Voluntary Service (CVS) until such time as they achieve
independence in their own right. In these instances a different kind
of independence takes priority. Although not structurally independent
in the way described above, it is essential that the schemes aspire
towards operational independence: in other words, their efforts on behalf
of service users are autonomous and unconstrained. However, the
relationship between advocacy and wider voluntary sector endeavours
may also be fraught with difficulties. As the voluntary sector has
embraced contracting and there has been an unprecedented shift


A right result?

towards not only general service provision but more specifically the
rebranding and repackaging of traditional statutory services within
the voluntary sector, so the advocacy movement has found itself at
odds with those who would previously have been allies and colleagues.
Consider this example:
Common roots, conflicting interests?
Anytown Older Peoples Project (AOPP) started out as a social club
for elderly residents of Anytown, run exclusively by volunteers and
supported by the local Council for Voluntary Service (CVS). However,
the advent of community care and the contract culture meant that
AOPP was suddenly in demand as a provider of day care to a much
wider client group, including those with dementia, older people from
minority ethnic communities and carers. As a result of a number of
astute funding bids, AOPP is now employing 35 staff across five sites,
with a further three day centres due to come on stream in the next
18 months. The next priority will be to develop low-cost domiciliary
care to older people in their own homes plus a put-to-bed scheme
for older people with dementia. In addition, AOPP has recently won
the contract to manage the meals-on-wheels scheme previously run
by the local council.
Anytown Advocacy Service (AAS) also began life as a volunteer-led
project supported by the CVS. Although not exclusively an older
peoples project, AAS is currently funded to provide advocacy to a
wide range of local service users in relation to their care and support
needs. The project staff and volunteers have become increasingly
concerned about the number of complaints they have received about
the quality of services offered by AOPP, particularly in relation to staff
shortages in the day centres and the poor quality of meals-on-wheels.
However, the AAS has come under pressure from other staff within
the CVS to go easy on AOPP, especially given their common roots.

It is because of such conflicts of interests that the advocacy sector has

fiercely maintained its independence, remaining aloof and somewhat
detached from other voluntary sector service providers. Although
advocacy is often characterised by its relationship with the statutory
agencies of health, housing and social services, it is just as likely that
an advocacy scheme will be required to challenge bad practice in a
voluntary organisation with charitable aims ostensibly similar to its


Issues in contemporary advocacy

A central tenet of all forms of advocacy is that the advocate, whether

paid worker or volunteer, citizen advocate or caseworker, has the
autonomy and strength of character to act independently on behalf
of their partner or client. The question for those charged with the
responsibility for ensuring this happens (in other words, scheme
coordinators and managers) is the extent to which such independence
can be achieved within a structure that does not have advocacy as its
core purpose.

Selection and support of advocates

It is not enough for advocacy schemes to simply be structurally or
operationally independent. The real test of that independence is the
extent to which advocates themselves are operating in a client-led,
autonomous fashion. This has implications for both the recruitment,
training and ongoing support of advocates, whether paid workers or
volunteers. An effective advocate may possess (or at least aspire to)
any number of useful attributes including tenacity, patience, empathy
and optimism. There is also a whole range of appropriate skills that
would prove beneficial, such as active listening, letter and report writing,
negotiation and communication skills and a working knowledge of
relevant legislation. It is up to individual advocacy schemes to decide
how these skills and traits will be identified (in the recruitment process)
and developed (via training and support). The challenge is to engender
in advocates a sense of intellectual independence, that is, a sense in which
loyalty to the client/partner, and a commitment to justice and
empowerment, are paramount. Although ultimately rewarding, the
process of advocacy is fraught with moral and ethical challenges which
can overwhelm even the most enthusiastic social activist. How can
advocacy schemes provide an environment in which this commitment
is not only an aspiration, but realised and sustained?
Even within structurally independent schemes, the temptation for
advocates to collude with service systems rather than remain loyal to
their partners is all too real. Advocacy can sometimes be a lonely
pastime, with few opportunities for positive feedback or information
sharing. Against this backdrop, advocates may find themselves seduced
by the camaraderie that often exists within large service provider
organisations, or lured by the trappings of professionalisation. This is
a failing of the advocacy movement as much as of the individual
advocate. Speaking up for disempowered individuals, often within a


A right result?

hostile environment is a high-stress activity and advocates may seek

support from wherever it is most readily available. If the advocacy
schemes themselves have adequate support systems for their staff and
volunteers then such problems would not arise. Support can be offered
in the form of training, regular supervision and appraisal, team meetings
and open door access to senior project staff. It is also desirable that
advocates have access to local support networks, which provide a
useful forum for sharing experiences with other advocates and can
help foster a sense of group identity unique to those involved with

Throughout its history the provision and availability of advocacy for
a wide range of potential beneficiaries has been sporadic, often based
more on the individual interests of those developing services than on
real local need. Up until very recently advocacy has too often been
seen as a fringe activity or an expensive luxury as opposed to a key
piece in the community care jigsaw. As a result, it has developed in a
piecemeal manner, dependent on local and national trends in funding,
opportunistic bidding or occasionally in response to crises and scandals
in local service provision. It is surprisingly rare that advocacy services
are developed as a result of strategic planning at a local (still less a
national) level. The result is an inconsistent pattern of advocacy delivery
that must be bewildering for potential users. Not only are different
client groups served differently, but users also have the different
advocacy forms to contend with. This situation is exacerbated by the
fact that there exists no logical or systematic method of deciding
which advocacy model is most appropriate in which situations.
Consider the following example:
Area 1 (urban)
Citizen advocacy for over-65s living in residential care
Paid advocacy for people with mental health problems
Volunteer crisis advocacy for homeless Afro-Caribbeans


Issues in contemporary advocacy

Area 2 (urban)
Paid advocacy for over-65s, carers and disabled people
Citizen advocacy for people with learning disabilities
Peer advocacy for young people looked after

Area 3 (rural)
No advocacy provision

Although it could be argued that inconsistencies such as those

illustrated above could be resolved with effective strategic planning,
this begs the question, whose responsibility is this? Most people within
the advocacy movement would resist any moves seen to be imposing
a uniform structure and code of practice on their activities. This is a
key dichotomy on the one hand needing to be independent, free
from conflict of interest, grassroots, radical and locally accountable,
and on the other wanting official recognition and status, long-term
security and national influence. Much of the current debate within
the national advocacy movement centres on this fundamental dilemma.
There are those within the movement who claim that some advocacy
(however patchy) is better than no advocacy; it is the responsibility of
local communities to represent the needs of local devalued people.
On this view, the impetus for advocacy should emerge not from the
strategic plan of some bureaucratic agency but from social clubs,
churches and workplaces. In other words, local people should promote
the interests of local people care in the community, by the community.
If advocacy should grow from the grassroots, then equity cannot mean
universal access imposed via top down advocacy strategies rather,
it would mean fostering provision that meets the disadvantages of a
particular area. In reality, however, it is often advocacy schemes
themselves that bang the drum for more comprehensive advocacy
provision in local areas. This dilemma is vividly illustrated below.


A right result?

Planning advocacy provision

The local health authority wishes to commission advocacy for people
living with HIV and AIDS. They contact all the existing advocacy
schemes in their area and invite them to a meeting to discuss how
the advocacy scheme might be run, and who would be best placed to
run it.
We believe that a Citizen Advocacy model would be most
appropriate, says the coordinator of the local citizen advocacy scheme,
given that HIV is a long-term condition and hence people would be
best served by a long-term, one-to-one relationship.
And where do you expect to find volunteers who are willing to identify
in a very personal way with a condition as stigmatising as HIV?, says
the manager of a professional casework advocacy project. It would
be more efficient to recruit a team of advocacy workers who could
work with larger numbers of people, dealing with crises as they arise.
You are all missing the point, replies the peer advocacy project
worker. People with HIV need to be supported by people who
themselves have been through the system. The most effective approach
would be peer advocacy.
My view is that whatever model we choose, the best provider would
be an agency already well-established in the field, who has a proven
track record in running a wide range of support services for this
client group, says the director of a large service provider organisation.
That way, we can integrate advocacy with other local service

Another feature of this dilemma is the extent to which existing

advocacy provision is able to engage with all sections of the local
community, and in particular with people from black and minority
ethnic backgrounds. Much of the available research suggests that
people from minority ethnic communities have an especially difficult
time trying to obtain relevant services, either because such culturally
appropriate services do not exist, or because mainstream services are
insensitive to their needs. In a mental health context, there appears
to be an even more serious problem. Not only are people from
minority ethnic communities less likely to be offered beneficial
treatments such as counselling and psychotherapy, they are more likely


Issues in contemporary advocacy

to be on the receiving end of coercive treatments like electroconvulsive

therapy (ECT), high levels of psychiatric medication, seclusion and
restraint (Fernando, 1991). Black people, especially young black men,
are much more likely to be sectioned under the Mental Health Act
than others (Francis et al, 1989; Bebbington et al, 1994). This represents
a serious civil and human rights issue and is something that many
mental health advocacy schemes are committed to challenging either
on a one-to-one or group basis.
As advocacy is generally considered to be most appropriate when
the needs and wishes of an individual or group are likely to be dismissed
(Robson, 1987), it could be argued that people from ethnic minorities
are in even greater need of advocacy, and one could expect that an
even greater proportion of advocacy scheme clients will be from
minority ethnic communities. Rogers and Pilgrim (1996, ch 7)
endorse the Mental Health Task Forces conclusion that the provision
of independent advocacy may be one way to improve mental health
services for the black community. Francis et al (1989) also call for
both legal and clinical advocacy to be made available to people from
ethnic minorities. However, in order for this to happen advocacy
agencies need to be both accessible and credible to all sections of the
local population. Equal opportunity is not only a goal for advocates
to pursue, it is a principle which all schemes must embody. Although
accessibility should be achievable, for example by ensuring publicity
materials are available in different languages and formats and by
organising open days targeted at particular minority communities,
the issue of credibility is more complex. In order to appear credible
to minority ethnic communities, to a degree that would encourage
people to make use of advocacy, a number of criteria would need to
be satisfied.
Availability. The extent to which the service is accessible and available
to minority communities. Is the office base in an accessible building
used by multiple communities? Does the scheme provide outreach
to local groups and community buildings? Do local minority groups
know about the scheme, via publicity, word of mouth, local networks?
Sensitivity. How does the service respond to enquiries from minority
communities? Are there black and minority ethnic advocates available?
Have all advocates had training on issues of race and culture? Is the
scheme flexible and person-centred?


A right result?

Language and cultural awareness. Do advocates and advocacy staff speak

community languages? Does the scheme have a procedure for using
interpreters? Are publicity materials available in different languages?
Does the scheme work collaboratively with local minority community
Anti-racist values and practices. Does the scheme have a workable equal
opportunities policy? Where are job vacancies advertised? Does the
scheme regularly review its core principles and practices? Are advocates
given proper support and access to training?
Structural and intellectual independence. Is the scheme autonomous and
free from conflicts of interest? Does the scheme have a local presence,
and is it locally controlled? Are people from minority communities
actively involved in the management and development of the scheme?
Do advocates act in an independent and client-instructed way?

As previously stated, advocacy is often most effective when targeted
at the least visible, least vocal, most vulnerable people in our
communities. The UK advocacy movement has developed largely in
response to the needs of users of community care services (older
people, people with physical and sensory disabilities or mental health
problems, people with learning disabilities, carers) and children and
young people in care. The shared experience of many such people,
especially those who have experienced periods of institutionalisation,
is frequently one of disempowerment and discrimination. A central
tenet of citizen advocacy philosophy is that devalued people (such as
those described above) can derive some benefit from an organised
matching with ordinary citizens who are prepared to engage in a
long-term, mutually beneficial relationship with them. The powerful
testimony contained in Standing by me (Williams, 1998) proves that
such partnerships can have a profound effect on the lives of both
advocate and partner. Here is an example:
My partner had quite a large sum of money at his nephews and
money in his flat, which concerned me as he was so vulnerable. I
arranged an appointment with a local bank, and went with my
partner to open a savings account where he could pay in his money.


Issues in contemporary advocacy

All this was done under the wishes of my partner, who agreed it
was a good idea. As my partner became anxious when attending
appointments, I attended two doctors appointments with him at
his local GP surgery. There was a Care Plan meeting at a local
hospital along with a review for my partner, and the social worker
invited us both along, which I thought was very good of them. I
really enjoy being a citizen advocate and find it very stimulating
and rewarding. (Williams, 1998, p 30)

Clearly, both the advocate and partner in this vignette benefit from
this relationship. On the one hand, the partner gains a confidante
and representative who is prepared to take positive action to further
his wishes and concerns, and on the other the advocate feels able to
make a difference in the life of another citizen. While it is unhelpful
to generalise on the possible motivation of people who act as advocates
voluntarily, the desire to give back to the community is clearly an
important driving force. By allying themselves in such a proactive
way with devalued people, advocates challenge deeply held beliefs
within society that reinforce the gulf between mad and sane, disabled
and non-disabled, rich and poor. In so doing, they are contributing
towards the development of a more tolerant society and a more caring
The loyalty that an advocate owes to their partner can be effective
in a number of ways, then. At its root, however, it means being on
the side of the partner in an unambiguous way. The rationale for
such a partial approach to supporting individuals is that the advocate
remains untainted by external concerns and pressures. For example,
an advocate can represent their partners wish for additional hours of
home support without concession to the resource problems of the
local authority. This is not the same as being ignorant of such
constraints, nor is it (as has sometimes been suggested) arrogance or
belligerence. It is simply that the advocates primary role is that of the
voice of the person in need. There are any number of other
professionals, and sometimes family members, who are quick to assume
the mantle of advisor, mediator or gatekeeper. The decision about
whether to award the extra care hours is not the advocates but an
effective advocate will ensure that their partners views have been
clearly represented and positively received.
Thus, a commitment to the individual and to the advocate and
partner relationship remains a fundamental principle of contemporary
advocacy. Without such a commitment, there would be a very real


A right result?

danger that advocacy becomes just another service, providing advice

or a version of social work. Some commentators have openly suggested
that the future of advocacy lies in pursuing just such objectives.
Atkinson (1999) clearly identifies informal social work as a possible
way forward for advocacy, in addition to helping to safeguard people
from abuse and neglect (see Chapter Three for a more detailed analysis
of this work). How far can the intangible but powerful quality of
loyalty be codified in a series of interventions? The answer given to
this question will indeed shape the future of advocacy provision; it
will be a key aim of this book to provide some sort of answer to this
However, it is sometimes argued that by focusing exclusively on
loyalty to the individual, advocacy denies the collective experience of
disempowerment and more importantly, the collective experience of
empowerment that is such a key feature of the service user movement.
For example, Bateman (2000) argues that:
Advocacy can also be limited in its effects by being too closely
linked with individualism. Most of the problems which advocates
resolve will be faced by hundreds of thousands of other people.
Not only can advocacy take on a collective form, but it is more
effective if used as part of a wider strategy for helping others.
(Bateman, 2000, p 181)

Organisations such as People First, Survivors Speak Out and the Direct
Action Network have enabled users to join together to challenge
inequalities and campaign for improved service provision and greater
recognition of peoples civil and human rights. Although the
methodology may differ, most user groups share the common aims of
encouraging people to take pride in their identity and campaigning
for a change in attitude towards disabled people. This collective
approach is in contrast to the individualistic model adopted within
advocacy. The advocacy and user movements can be seen as allied
and complementary rather than unified, although there are strong
links between user groups and the concept of self-advocacy. Whether
advocacy schemes could and should do more to align themselves
with the user movement will be considered in Chapters Five and Six.


Issues in contemporary advocacy

Whenever the term community care is used these days, it seems that
risk management will follow with the next breath. Whereas, 20
years ago, scandals concerning the abuse of patients helped to seal the
fate of the long-stay hospitals, now media attention seems to play a
much more ambivalent role. Tragic instances of killings by individuals
with mental health problems have created a perception of this group
as presenting an undue risk to the public, and therefore needing closer
supervision. Even where service users themselves are the victims of
crime, this tends to be blamed on a lack of support from service
providers, rather than on the criminality of the perpetrator.
It is small wonder, then, that services have felt the need to adopt
strategies which aim to protect both users and the public, and to
defend themselves against litigation or public criticism. It is equally
unsurprising that service users and their advocates have viewed this
double agenda as potentially undermining of individual freedom and
development. Risk management appears to restore to the medical
model of care much of the power and prestige it lost when care in
the community was first implemented.
Yet if the advocacy movement is rightly wary of risk management,
it cannot afford to ignore the question of individual vulnerability
either. How does an advocate or scheme respond if a partner discloses
abuse? What steps do schemes take to ensure that abusers do not
become advocates? How can an advocate help someone who has
severe learning difficulties and mental health problems to discover
positive opportunities if they do not know what circumstances are
likely to make that person anxious or unwell? How do schemes deal
with the possibility that they may be the objects of litigation by
dissatisfied partners or advocates? If any of these questions require
credible, sustainable answers and we believe they all do then
advocacy schemes need at least some systems by which they can assess
and respond to risk. There are three main areas where a form of risk
assessment may be appropriate:
risk to the advocate
risk to the partner
risk to the advocacy relationship.
Risk to the advocate. To the extent that advocates like many others are
operating at the front line then they are at risk of violence and


A right result?

aggression from people who may be unhappy with the way they have
been treated within service systems. Although advocates identify
clearly with the views and concerns of their partners, there will be
times when the advocacy role is not well understood and the advocate
is perceived to be part of the system. In addition, there are inherent
risks associated with any form of outreach work which involves visiting
people in their own homes, especially in the early stages of an advocacy
relationship when boundaries are not yet negotiated or agreed.
Another potential risk is that partners may develop unrealistic
expectations of what their advocate will be able to achieve, and become
disappointed if progress is not as quick or comprehensive as they
would like. It is therefore incumbent on schemes to ensure that
advocates are briefed and supported in the process of risk assessment
without raising undue concern or fear.
Risk to the partner. By this we mean risk from the advocates themselves,
whether in the form of physical, financial or emotional abuse.
Although most advocacy schemes adopt stringent recruitment and
selection processes (and many require police checks on their advocates),
there will still be occasions where an unscrupulous individual slips
through the net and goes on to abuse their position of trust for their
own ends. In such a situation, the advocacy scheme needs to be able
to demonstrate it has the capacity and will to learn from its mistakes
and take swift action to avoid any repetition of events. Advocacy
partners should also be given easy access to complaints procedures
and to scheme managers or coordinators in order to minimise the
risk of a culture of secrecy emerging within both advocacy
partnerships and the wider scheme.
Risk to the advocacy relationship. By its very nature, advocacy exists to
challenge inequalities and highlight areas of bad practice or neglect.
In so doing, advocates and their partners run the risk of being targeted
or threatened by the perpetrators of such acts. This is particularly
true in institutionalised or segregated settings where there is a large
social control element to the environment or culture. Advocates, like
whistleblowers, have been victim to threats and assaults as a result of
their role in exposing malpractice on behalf of their partners. There
may be a potential role for codes of practice for advocacy which
place value on the advocacy role and outline measures to safeguard
advocates and partners from such intimidation.


Issues in contemporary advocacy

How to evaluate advocacy?

There is currently no widely accepted standard framework for
monitoring and regulating advocacy in the UK. Although the United
Kingdom Advocacy Networks (UKAN) Advocacy: A Code of Practice
(UKAN, 1997) and the type of code suggested by Citizen Advocacy
Information and Training (Wertheimer, 1998) are influential in their
respective fields, neither has been adopted as comprehensively as some
may have wanted. Local advocacy initiatives have developed largely
autonomously with their own identities, procedures and monitoring
arrangements. While this has undoubtedly led to more localised and
informal arrangements for users, the problem of how best to promote
and monitor effectiveness remains. In the absence of agreed standards
the monitoring agenda has increasingly been set by funding agencies,
who often have little knowledge or regard for the particular aims and
methods of advocacy schemes. The tendency to fall back on tried
and tested quantitative measures means that the intrinsic value of
advocacy the stories of advocates and partners, the quest for social
change and justice often goes unmeasured and hence unrecognised.
This is not to say that advocacy schemes should be exempted from
any monitoring or regulatory requirements: if schemes are accepting
public money, they should be prepared to be held to account for how
that money is spent. The issue is about how advocacy programmes are
most appropriately measured rather than if they should be. In
subsequent chapters it will be argued that traditional service measures
do not provide sufficient depth or sensitivity truly to demonstrate
the worth of advocacy in the lives of disempowered people.
Although schemes will certainly aspire to having basic service
standards and measures in place (waiting times, ethnic monitoring,
complaints procedures and so on), they also need to develop the means
to provide some evidence of the more cerebral and empowering
aspects of advocacy. At the very least these should include some
evidence of effective advocate/partner matching processes (based, for
example, on factors such as common interests, skills match, cultural
and language needs); the minimisation of dependency and
maximisation of empowerment; a focus on outcomes as well as
processes; and a commitment to equality of opportunity.
It is clear that a qualitative approach to data collection will be
required in order to obtain the appropriate information as outlined
above. There are a number of factors which conspire to make such
data collection problematic in an advocacy context. For example,


A right result?

there is a lack of agreement as to what constitutes effective advocacy.

The concept of advocacy is still a relatively new one, and levels of
knowledge about advocacy among the general public are poor. There
is no clearly defined frame of reference by which people can judge
whether the advocacy support they receive is good or bad. When a
customer goes into a high street burger bar they have a very good
idea of what to expect what the burger will look and taste like, how
it will be packaged, how much it will cost. There are no such easily
quantifiable standards for advocacy and hence, no simple way of
comparing peoples experiences of advocacy to a set of pre-determined
and consistent standards.
Is there then a place for national standards in regulating advocacy
provision? On the one hand, the vulnerability of some of those
supported by advocates (people with dementia, those who have
experienced abuse) suggests that some common safeguards are
required. On the other hand, the diversity of advocacy forms, and
their jealous guarding of advocacy practice, suggests that such standards
may be impossible to develop. Chapter Six will pursue this question
Similar questions arise in relation to the training of advocates. If
advocacy is a skill, it should be possible to develop and refine it through
training. On this view, the accreditation of advocates through, say,
National Vocational Qualifications (NVQs) seems a possible, even a
desirable course. If, however, advocacy is primarily about one persons
commitment to anothers cause, training will be at best a secondary
issue. The subject of training is explored in more detail in Chapter
A key question in both the opening chapter and this has been
What constitutes good advocacy? If the advocacy movement is
serious in its pursuit of secure funding, if it is concerned to maintain
a coherent values-base for advocacy practice, it must be able to answer
this question. Mechanisms for evaluating advocacy will have a central
place in any such answer; and it is with the question of evaluation
that the next chapter is concerned.



Problems in measuring
advocacy outcomes

In Chapter One, a lack of identity, coherence and consistency were

identified as obstacles to the continued development of the advocacy
movement in the UK. Chapter Two looked at the ways in which this
overall lack of stability placed question marks over key advocacy
principles such as independence and loyalty. Yet these problems exist
against a backdrop of dynamism, growth and well-attested success
within the advocacy movement. How in the jargon of the business
world can the advocacy movement marshal its strengths to counter
its weaknesses?
Dorothy Atkinsons Advocacy: A review (1999) seeks to undertake
the first part of this task: to establish a baseline for existing advocacy
provisions, and to suggest ways of developing them. This work gives
a good outline of the different types of advocacy schemes that operate
in the UK. Atkinsons fieldwork provides ample evidence that:
Advocacy is an empowering process this applies across its many
manifestations, from supportive self advocacy groups, through peer
advocacy schemes, to citizen advocacy, and advocacy provided by
paid sessional and full-time workers. (Atkinson, 1999, p 22)

This finding could be a springboard for the development of an

advocacy movement diverse in its practices yet unified around the
central concept of empowerment. But this is unlikely to happen.
One of the things that stops advocacy from working effectively is
the internal division about what it is, who does it and who it is
for. Some disabled people see citizen advocacy in its pure form
as potentially a devaluing process in itself. (Atkinson, 1999, p 25)

To cite one example of these divisions: the citizen advocacy model is

seen to hinge on the provision of valued citizens to advocate for


A right result?

apparently devalued partners. Some disabled people see this as simply

reinforcing perceptions that they are invariably needy or dependent,
never able or empowered. Needless to say, the citizen advocacy
movement emphatically rejects this criticism; it sees advocacy
partnerships as the best way to challenge these false perceptions. Yet
the disagreement could hardly be more profound: what one side sees
as the answer is seen by the other as a further problem.
Whether or not there is a right answer here, the argument shows
that the advocacy movement clearly has problems in establishing a
purely descriptive baseline for advocacy practice. Advocacy processes
appear to be inseparable from the value-claims made for them. Thus,
John OBriens definition of citizen advocacy is also a claim for its
results, describing:
A valued citizen ... bringing their partners gifts and concerns into
the circles of ordinary community life. (OBrien, quoted in
Atkinson, 1999, p 7)

Similarly, Atkinsons own definition of peer advocacy describes both

the process and the anticipated result, as though they were almost the
same thing:
The advocate in this instance is an insider, someone who is in the
know through personal experience of disability or mental health
problems, and so can draw on that experience to show empathy
and understanding. (Atkinson, 1999, p 7)

Time and again in advocacy one comes across this blurring of aims
(what an advocacy scheme is trying to achieve) and principles (the
rules describing how a scheme will go about achieving its aims). When
Atkinson writes that advocacy is about empowerment, autonomy,
citizenship and inclusion (1999, p 16), it is clear that these are not
only the benefits it aims to bring, but also the kinds of practice which any
credible scheme should follow. It is as though there is something
exemplary about the advocates role; they are not just deploying various
tactics in order to get a result for their partner, they are developing a
particular kind of relationship with that person, one which is meant to
change and inspire the way that others relate to them. The blurring
of aims and principles marks advocacy out as an arena which aspires
to commitment, conviction, and direct social change.
Yet if this blurring shows the strong ideals (and high expectations)


Problems in measuring advocacy outcomes

which lie behind advocacy, it is also a breeding ground for confusion

within the advocacy movement. It is all too easy for advocacy schemes
to assume that because their aims are worthy, and their practice
principled, valid outcomes must inevitably be achieved. To return to
the argument between citizen and peer advocacy cited above, there is
an assumption in each case that because the advocate has something
plausible to offer (valued status in the case of the citizen advocate,
solidarity in the case of the peer), this will necessarily be transmitted as
a benefit to the advocacy partner. But this is not so; in either case, any
one of a dozen factors could neutralise this potential benefit. The
advocate, for all their apparent suitability as a citizen or peer, may lack
sufficient commitment to their role or the partner may simply not
like them. The advocate may not have the skills required for a particular
situation, or may be inadequately supported. To put it another way,
an advocacy scheme may be principled without necessarily being
effective. While a certain blurring of aims and principles may be a
hallmark of true advocacy, the confusion of aims with results should
be challenged.
If principles alone cannot measure the impact of individual advocacy
schemes, this task must be completed by evaluation. Interestingly,
although it contains much feedback from users of advocacy, Advocacy:
A review (Atkinson, 1999) is virtually silent on the subject of formal
evaluation. This silence detracts from the authors otherwise valid call
for the development of an advocacy culture a key concept which
will be more fully explored in Chapter Five. Evaluation which links
principles, practice and outcomes and generates evidence which can
inform practitioners, users, funders and others, should be the bedrock
of this culture. Without it, attempts to promote advocacy as a whole
will founder amid the competing and unverified claims made for the
principles and relative merits of different types of schemes.
Atkinsons own conclusions and recommendations are in fact
somewhat disappointing in their lack of confidence in the distinctive
nature of advocacy. She rightly observes that,
... advocacy often means more than supporting people to have a
say in their lives, it means supporting them in managing their
lives. (Atkinson, 1999, p 34)

But this does not entirely warrant her description of advocacy as the
reinvention of social work. Social work is societys intervention,
however benign, in the life of the individual; advocacy gives the


A right result?

individual the right to intervene in and to change social and service

processes. Again, Atkinson correctly asserts that: advocacy has the
potential to protect people from abuse (p 35), but her statement that
childrens advocacy (seemingly because of its use of professionals as
advocates and more rigorous procedures) has most to offer in this
respect seems arbitrary. Are not other kinds of advocacy also effective
in preventing abuse? In fact, it might be argued that the best
watchdogs of services prone to commit abusive or unethical practices
are those without a professional background and hence free from the
preconceptions which come from years of working in human service
The lack of a clear evaluative framework undermines the attempt
to develop the concept of an advocacy culture and, arguably, leaves
Atkinsons recommendations for the future of advocacy too close to
social work models. But her lack of reference to evaluation is
understandable if one recognises that there are currently very few
designated models of advocacy evaluation. The main ones are
considered below.

Citizen Advocacy Program Evaluation

Citizen Advocacy Program Evaluation (CAPE) was developed by John
OBrien and Wolf Wolfensberger (1979) in the late 1970s. It was
subsequently complemented by OBriens Learning from citizen advocacy
programs (1987). CAPE comprehensively defines the principles of
citizen advocacy, and requires the evaluator to rate a schemes success
in implementing each principle, usually on a scale of 1 to 4, with 1
pointing to major deficiencies in complying with the principle of
the rating with 4 denoting distinctly positive implementation
(OBrien and Wolfensberger, 1979, p 3). The ratings are given their
impetus above all by the authors demand that citizen advocacy be as
unlike human services (care services) as possible. The independence
of advocacy schemes is upheld, not only so that advocates can act
freely, but also so that the scheme does not look or feel like a care
service. Advocates must have a primary loyalty to their partner in
order to speak with conviction on their behalf, and to avoid the
advocacy office becoming the dominant player in the relationship;
becoming, that is, a human service. Twenty years on, it is easy to
forget how radical this rejection of the service approach was and is.
For OBrien and Wolfensberger, the crucial first step in the defence


Problems in measuring advocacy outcomes

and promotion of peoples rights is the establishment of relationships

based on conviction, not money. In place of paid care services which
are seen as segregating, stigmatising and controlling, they propose an
advocacy which is freely given, open-ended and inclusive. CAPE is
therefore intended not only as a positive record of advocacy
implementation; it is also seen as an enduring safeguard against the
possibility of advocacy being taken over by a hostile service culture.
CAPE is still used by UK citizen advocacy schemes, although there
are perhaps only one or two such evaluations each year. CAPEs
strengths are several. First, it establishes the importance of the links
between principles and practice in advocacy, and provides tools for
assessing and developing these links. Second, it provides (if used by a
qualified evaluator) an objective measure of a schemes performance
against a set of constant standards. Finally, it highlights the way in
which evaluation can and should be an integral part of a developing
advocacy culture which is entirely distinct from service models.
But there are a number of difficulties surrounding CAPE, too, which
perhaps explain why it is relatively little used. First, there are cultural
difficulties in CAPE for UK schemes. For instance, to score even a
satisfactory level 3 rating, a scheme is required by CAPE to have 6080% of its funding from non-service funders and its funding should
come from three to five different funding sources. In a country where
corporate and charitable trust giving lags far behind the US, and local
government has traditionally been the only core funding agency for
local voluntary groups (while providing many care services of its own),
this seems a tall order. CAPEs ratings system can appear to punish
schemes for cultural and political conditions which lie far beyond
their control.
Second, and crucially, CAPE does not offer any measure of or
comment on a schemes impact. Even Learning from citizen advocacy
programs, while offering guidelines for interviewing advocacy
partnerships, admits that it:
... says little about the wide variety of things people in citizen
advocacy relationships actually do together. (OBrien, 1987, p 1)

This reticence is understandable. The citizen advocacy partnership

should be owned by advocate and partner, not by the scheme. A
citizen advocate does not have to report back to their scheme in
order to have their activity validated or assessed. Nonetheless, silence
on the subject of impact means that a CAPE evaluation is unlikely to


A right result?

promote the value of a schemes endeavours to the sceptical. It will

be of limited use in showing funders how their money is being spent.
CAPEs audience may in the final analysis be a fairly narrow one,
consisting primarily of advocacy movement insiders.
At worst CAPE could (and perhaps has) contributed to the
development of a climate in which a schemes purity (its adherence
to principle) is taken as a guarantee of its effectiveness in helping its
partners. Such assumptions are not justified: principles may be essential,
they are not sufficient. There is a danger here of elitism, of placing
theoretical proficiency ahead of the core citizen advocacy values of
inclusiveness and relationship.
Finally, CAPE is, by definition, only an evaluation of citizen advocacy
schemes. Other types of scheme may gain insights from it, but could
not be evaluated by it. Indeed, CAPE seeks to distance citizen advocacy
from other types of advocacy almost as much as it does from human
Clear and effective staff functioning requires non-competition
with other advocacy roles. (OBrien and Wolfsenberger, 1979, p

Granted the need for clarity, one still wonders if there are not valid
and informative questions to be asked about how a citizen advocacy
scheme relates to other advocacy schemes in its locality. The citizen
advocacy movement could offer counter-arguments to each of these
points, and it is true that the criticisms may be a matter of perception
as much as of substance. But perceptions matter; in order to fulfil its
role, an evaluatory system must be credible to all interested parties.
None of this is to deny that CAPE has been, and continues to be,
a source of inspiration for citizen advocacy in the UK. Its standards
are a touchstone for schemes even if they cannot comply with all of
them, and CAPE evaluations have been an effective developmental
tool for the schemes they have covered. Our review has suggested
that there may need to be evaluatory mechanisms for citizen advocacy
in addition to CAPE. Such is the remit of the CAIT evaluation pack
described below.


Problems in measuring advocacy outcomes

CAIT evaluation pack

Citizen Advocacy Information and Training (CAIT) produced its
evaluation pack in 1998, after a considerable period of consultation
with citizen advocacy schemes (Hanley and Davies, 1998). The pack
addresses two of the difficulties in CAPE: the sometimes arbitrary
system of ratings and the lack of information about advocacy
partnership activity. The CAIT pack sets out the same citizen advocacy
principles as CAPE, but allows for the fact that individual schemes
may not aspire to meet all of these standards all of the time. Local
conditions may make different aims necessary or desirable. Schemes
are therefore measured against their own aims, as well as against citizen
advocacy principles.
A CAIT evaluation team will seek to meet with eight citizen
advocates and their partners within a given scheme as part of the
evaluation process. The purpose of these meetings is not to evaluate
the partnerships themselves, but to gain from them an understanding
of how the scheme is working in practice. By interviewing
partnerships, the evaluator can begin to identify, for example:
the range of people the scheme is helping
the types of role advocates are taking on (for example, friend,
negotiator, information gatherer etc)
how well the scheme has prepared advocates for their role
how far advocates are loyal to their partners, rather than to the
Thus, when used by trained evaluators, the CAIT pack should convey
not only technical information about the meeting of aims and
standards, but something of the feel of an advocacy scheme.
However, in interviewing advocacy partnerships, the CAIT pack
still basically adheres to the idea that to act in a principled way is to be
a successful advocate:
We believe that the process of citizen advocacy is important and
valuable in itself, over and above outcomes. (Hanley and Davies,
1998, p 17)

Certainly, it would be entirely inappropriate to form judgements about

individual citizen advocacy partnerships; as freely given relationships,
these cannot be measured against a common standard any more than


A right result?

people can. Confidentiality, too, is a barrier to gaining a full picture

of a schemes activity from its partnerships: a partner who has been
helped through a traumatic, personal crisis by their advocate is unlikely
to expose themselves to interview, yet their partnership may be one
of the schemes most significant outcomes. Still, the CAIT pack does
not really generate a sense of the schemes overall impact. Partnerships
do not have to be evaluated, but the evidence gained from them
could perhaps be joined up in some way. Does the evidence say
something about the ways in which the scheme is influencing the
local community, or local services, for instance?
Like CAPE, the CAIT evaluation system seems to be addressed
primarily to advocacy insiders. The introduction talks of its role in
... encouraging schemes to feel positive about whats going well,
and learn more about how they can improve more difficult areas.
(Hanley and Davies, 1998, p 3)

If advocacy was universally seen to be a worthwhile activity, and citizen

advocacy was agreed to be the pre-eminent model, this approach
might be sufficient. But neither is the case. All of the bodies who
fund citizen advocacy (be it local government, the National Lottery
[now called Community Fund] or charitable trusts) face large and
competing demands on their resources; should not evaluation assure
them that their money is being spent, not only on a principled and
competent organisation, but also on a significant and effective activity?
Nor is it only funders who may need to be educated and persuaded
by advocacy evaluation. User groups, carers, ratepayers and even the
services with whom advocates come into contact may all have differing
kinds of interest in what an advocacy scheme is doing, and how well
it is doing it. Perhaps some of these groups should be represented
within the evaluation process. Talking to a service manager might
shed light on a schemes activity. Of course, he or she may simply
wish to denigrate a scheme that is asking awkward questions of their
service, but a well-structured interview should expose such agendas.
The CAIT evaluation pack, then, has much to recommend it, but
still poses three problems:
it is heavily focused on principles, at the expense of outcomes
it is addressed primarily to others within the advocacy movement
it is only designed for citizen advocacy schemes.


Problems in measuring advocacy outcomes

Three years before the publication of the CAIT evaluation pack, a
very different evaluation appeared, which anticipated and sought to
tackle head-on the three problems set out above. ANNETTE, the
Advocacy Network Newcastle (ANN) evaluation tool (ANN, 1995),
sought to make an advocacy schemes principles subordinate to its
goal achievement. It sets out tables for recording any issues which an
advocate has helped their partner to identify, raise or resolve during
the period under review. The issues are counted up and, though
there is a place for commentary on some of these, it is the numerical
tally that is the primary measure of the schemes impact. As the authors
We wanted to develop quantitative measures for the qualitative
change brought about through advocacy. (ANN, 1995, p 7)

The impetus for this radical approach comes from ANNETTEs

intended audience. Whereas CAPE and the CAIT pack are addressed
primarily to those within the advocacy movement,
ANNETTE was developed in response to the needs of purchasers
who wanted to be sure that the effectiveness of advocacy could be
measured to ensure that they were getting value for money.
(ANN, 1995, p 7)

And although ANNETTE is designed to be compatible with citizen

advocacy principles, it could just as easily be used by schemes offering
short-term or professional advocacy. For advocacy processes too are
measured, not in terms of principles, but in terms of numbers. Types
of advocacy role are grouped under six headings (mediator,trouble
shooter, special friend, confidant, guide, and lifeguard) and the
number of advocates taking on each type of role are added up.
ANNETTE also records the number of hours given by advocates
during the review period as a further indicator of process.
ANNETTE envisages an advocacy culture that is driven by outputs
and outcomes. It holds out to advocacy schemes of all kinds the
prospect of straightforwardly measuring, and demonstrating, their
impact. A corollary of this, of course, is that schemes could also be
compared with each other using standards derived from ANNETTE,


A right result?

with some being judged better than others. The world of outputs
and outcomes is also the world of competition.

The service culture and Best Value

There are significant problems with the ANNETTE approach, which
will shortly be discussed. But whatever its shortcomings as an
evaluation tool (and it does not seem to have been widely used by
advocacy schemes) ANNETTEs authors clearly understood the
funding and monitoring environment in which the advocacy
movement found itself at the end of the 20th century. The key fact
here is that the majority of UK advocacy schemes are, as Chapter
Two showed, core funded by local authorities (and to a lesser extent,
the NHS). The most obvious problem this creates is potential conflict
of interest; an advocacy scheme that is funded by a social services
department may find it difficult to challenge the actions of that
department. Or, if they do challenge, they may face the withdrawal
of their funding.
Conflict of interest poses a real threat to the independence and
effectiveness of advocacy schemes. But it is arguably not the greatest
threat associated with current advocacy funding arrangements. This
comes from the whole service culture in which local authorities and
the NHS now operate. The roots of this culture lie in the revolution
which swept through industry in the 1980s. Where previously the
commercial and political worlds had been preoccupied with concerns
about the production of goods, with questions about industrial strategy
and workers rights to the fore, the Thatcher era saw these concerns
replaced by a single-minded focus on meeting the needs of the consumer.
The same shift saw the competing ideologies of the industrial era
displaced by the post-ideological concept of the service.
This revolution in outlook was introduced to the public sector in
the 1990s. Its guiding principle was quality, and its effects were felt in
a much more directive managerial culture, and in the introduction of
compulsory competitive tendering. Providers of services no longer
held that status as of right; the fact that they were doing something
worthwhile in itself (as the CAIT evaluation pack describes citizen
advocacy) counted for nothing, unless they could show that they were
doing it more efficiently and more effectively than other providers.
Not only local authorities themselves, but also the voluntary
organisations that they funded, were caught up in the demands of the


Problems in measuring advocacy outcomes

Figure 1: The service model



How many?

How fast?

How accurate?

How costly?

contract culture. If we were to try to model this culture as it affects

the provision of community and welfare activities, it might look
something like the above (see Figure 1).
There are two key concerns for an organiation following this model.
The first is that it should be achieving demonstrable results or
outcomes, and the second is that it should be achieving these with
maximum efficiency: as many as possible, as quickly as possible, as
accurately as possible, for the least cost possible. In its current political
form, this is the culture of Best Value.
Best Value is defined by the 1999 Local Government Act which
requires local authorities to,
Secure continuous improvement in the way in which they exercise
their functions, having regard to a combination of economy,
efficiency and effectiveness. (DETR,1999, p 3)

In order to meet this requirement, local authorities must undertake

Best Value reviews of all their services, whether they provide these
directly or purchase them from independent provider agencies.
Underpinning all such reviews are four key principles:

challenging why and how a service is being provided

comparing performance with that of other similar services
consulting service users and taxpayers to set new targets
using the principles of fair competition in deciding who should
provide the service.

It is not the purpose of this book to attempt to evaluate Best Value

culture as a whole; doubtless it has brought both gains and losses.
What is important here is the impact it is having on advocacy provision.


A right result?

As we noted above,ANNETTE is an evaluation tool which anticipates

and is at home in a Best Value environment. It is pragmatic (it can
accommodate a range of advocacy styles), it measures both process
and benefit, and it allows comparison between schemes. Indeed, while
ANNETTE was designed to be compliant with citizen advocacy
principles, its emphasis on statistics means that in any comparative
evaluation, a professional casework advocacy scheme which simply
helped people through particular problems and then stopped working
with them would be judged better than a citizen advocacy scheme
based on long-term partnerships that may go through spells where
there are no obvious issues to address.
This does indeed appear to be the conclusion reached by many
Best Value funders. While the recent growth of casework advocacy
schemes and relative decline in the number of citizen advocacy schemes
doubtless reflects a range of factors (for example user groups wishing
to develop their own models), there can be little doubt that funders
perceptions have played a major role here. An extreme confirmation
of this trend is given by the appearance in one or two parts of the UK
of spot purchased advocacy. Under this arrangement, there is no
core funding provided for advocacy. Instead, social services managers
make one-off payments to an advocacy provider whenever they
determine that one of their clients needs an advocate. This approach
has two significant implications; first, that local authorities become
the gatekeepers for advocacy, removing much of its independence in
the process, and second, that in the absence of core funding for agencies
which concentrate their energies entirely on advocacy, advocacy could
only be provided by organisations which gain their regular income
from one or another form of service provision. It will be argued in
Chapter Five that this trend undermines the provision of good
advocacy. For now, it is sufficient to note that Best Value may not
simply regulate advocacy; it may also alter its principles and practice.
Is this not a good thing? If one type of scheme achieves more
results than another, and does so more efficiently, should not that
type of scheme come to predominate? Put like this, the case seems
unarguable. If, on the other hand, the Best Value approach is based on
a mistaken assumption about what good advocacy is, and if in the
making of that assumption, fundamental advocacy needs have been
distorted or ignored, one would have to question the validity of this
approach in evaluating advocacy.
There are, in fact, four grounds for challenging the Best Value


Problems in measuring advocacy outcomes

approach adopted by ANNETTE and many scheme funders. These

may be characterised as follows:

the ambiguity of measurable outcomes

the preventive effects of advocacy
difficulties in gaining user feedback
the rationing agenda.

The ambiguity of measurable outcomes

A key premise of ANNETTE is that an advocacy schemes effectiveness
can be measured by the extent to which it helps partners to achieve
goals; these equate to measurable outcomes in the model in Figure
1. In the market system from which the Best Value approach draws
much of its inspiration, outcomes are often easily monitored. If, for
example, someone buys an insurance policy, they will judge it successful
if they receive the correct amount of money when the insured event
occurs, and if the company handling the claim is courteous and
It is tempting to think that advocacy outcomes would be similarly
easy to pin down. Certainly, the language used by health and social
services during the past 10 years and the proliferation of charters
defining levels of service, suggest a providercustomer contract similar
to the insurance purchase just described. Yet the outcomes these
organisations aim at, and the processes through which they are to be
achieved, are much more complex than commercial transactions.
Health cannot be bought over the counter in a box, and exactly what
constitutes helping disabled people to live independently in the
community, for example, may be defined in a dozen different ways
by consumers and providers. In these instances, it is much harder to
provide unambiguous indicators of success.
The danger here is that arbitrary or incomplete criteria are used for
judging the success of health or social care activities. A notorious
illustration of this can be found in the NHS waiting lists initiatives
launched by the government in the early 1990s. Here was a worthy
objective, if ever there was one: that fewer people should wait less
time for surgery. The means for reducing the waiting lists was the
introduction of targets: no patient should wait longer than a certain
period of time for surgery. Here, too, was apparent success: within
months, waiting times had come down the goals were being met.


A right result?

Only slowly did it emerge that at least part of the reduction in waiting
times was an illusion; many patients were now having to join unofficial
waiting lists before being put onto the official one. Similarly, an
apparently impressive growth in the numbers of patients treated was
at least partly accounted for by the fact that patients who had been
discharged too soon from hospital (so that new patients could be
admitted in order to meet waiting list targets) and then had to be readmitted, were counted as new patients. An apparent success masked
a real and serious failure.
Doubtless, performance indicators within the NHS have undergone
considerable refinement in the intervening years, but similar arguments
persist. At the time of writing, the government is proclaiming its
success in reducing waiting lists, while the opposition seeks to highlight
an increase in waiting times. Our story highlights three potential
problems for the use of measurable outcomes in the social care sector:
apparent success may not equal real success
the use of targets may distort the very activity they are supposed to
the goals or targets selected may reflect the needs of the funder (a
government in need of good news for example) rather than the
needs of users.
Each of these points highlights difficulties for a model of advocacy
that places too much emphasis on goal-achievement as the measure
of its success. It could be genuinely informative for an advocacy
scheme to collate figures showing the number of partners it has helped
with housing problems or benefits tribunals. But it would be
misleading to try to set strict standards for success in terms of how
many tenancies advocates have brokered, or how much additional
benefit has been won. An advocate might succeed in getting their
partner discharged from a Mental Health Act section, but if that person
is re-sectioned a few weeks later because too little thought was given
to their after-care, what sort of success is this?
Second, there is a real danger that a scheme that focuses primarily
on goal achievement will tend to work primarily with those who
are able to make their wishes known fairly readily. How, for example,
would a goal-based scheme work with those who have severe learning
disabilities or dementia? Would it create long-term partnerships with
them, recognising that these may not produce results for a long time?
Or would it, under pressure to achieve outcomes, allow its advocates


Problems in measuring advocacy outcomes

to act as arbitrators, substituting their views for those of the partner?

Or indeed, would it simply not work with these groups at all? If it
follows the latter options, are we not entitled to say that the schemes
work has been distorted by its pursuit of measurable outcomes, and
that it is no longer working in an ethical way with those very
disempowered groups who arguably have most need of advocacy?
Comparing the effectiveness of different advocacy schemes, as the
Best Value process envisages, seems sound in principle, but if the data
on which the comparison is to be based are contrived or misleading,
the process is worthless.

The preventive effects of advocacy

Roger had lived for many years in a long-stay institution. He moved
to a group home eight years ago, where he used to respond to stress
by banging his head or biting his wrist. He was introduced to a citizen
advocate, Mark, and soon began to go out with him regularly. Mark
encouraged Rogers interest in photography, and they built up a large
scrapbook. Mark was careful to give Roger the final say on what went
in the scrapbook. After about 18 months, Mark attended Rogers
review meeting, where staff commented on the reduction in Rogers
distress behaviours. His medication was reduced as a result. Although
Mark rarely spoke on Rogers behalf, he had helped him to feel much
more certain of himself.

A professional advocate with a mental health scheme found she was
getting many enquiries from residents in a group of private hostels
who felt they had no control over their personal finances. Finally, she
asked social services to investigate. No wrongdoing was proven, but
within six months social services had issued a new code of conduct
for service providers, and many more service users were able to set
up their own bank accounts.

US citizen advocacy schemes have always referred to the people they

support as protgs. The term is not used in this country, perhaps


A right result?

because it is perceived as paternalistic or patronising. Yet the term

contains one important truth that is anecdotally confirmed by many
advocacy schemes: that the mere presence of an advocate within a
given situation tips the balance of power at least some way back towards
the person they represent. The two brief anecdotes cited above seem
to highlight this sort of effect. In neither case is there a clear goal,
but in each instance something important has undoubtedly happened.
In Rogers case, he has probably been spared further physical pain
and risk, and perhaps the need for psychological or medical treatment,
but it cannot be proved that this was the result of advocacy. In the
second story, entire service processes have changed, with benefits to
many users, but there is no proven link with the actions of the
The preventive effects of advocacy can perhaps only fully be
articulated through stories like those given above; they cannot be
reduced to a series of comparative indices.

Difficulties in gaining user feedback

Perhaps the most simple and direct way to evaluate a service used
by shops and public authorities alike is to ask for the views of its
customers. Consumer satisfaction is generally seen as one of an
organisations greatest assets, and the key indicator of its success. This
is reflected in the BestValue guidance already quoted, which highlights
the importance of consulting with service users. In some ways, it is
surprising that the advocacy movement has not generated more in
the way of systematic procedures for gaining comments and complaints
from its users or partners. The tradition of telling partnership stories
in citizen advocacy goes some way towards meeting this need, and
Standing by me (Williams, 1998) gives many good examples of this, but
still one wonders exactly how schemes are finding out, for example,
whether partners are happy with their advocates and how they respond
if the partners are not happy.
It seems likely that much more could be done to collect user
feedback in a systematic way, and to use the evidence gained to improve
advocacy practice. But here, too, a note of caution must be sounded.
A complicating factor in attempting to collect accurate data about
advocacy is what has become known as the halo or hero effect.
People often approach advocacy schemes at the point at which their
own efforts to resolve problems have failed. Approaching an advocacy


Problems in measuring advocacy outcomes

scheme for help requires a great deal of courage, and a significant

emotional and psychological investment on the part of the client/
partner. In order to justify this investment, clients/partners will
sometimes go to great lengths to ascribe high status to their advocates,
believing them to have special skills or inside information which can
be utilised on their behalf. Of course, there may be some truth in this
(advocates often do have a great deal of experience in tackling issues)
but, coupled with the fact that advocates are often described by clients/
partners as the only person who listens to me, it is clear why some
caution should be exercised in relation to analysing peoples rating of
their advocates performance.
Of course, some advocacy partners can give very clear feedback.
At the National Mind conference held in London in 1999, Dr Rachel
Perkins, a mental health service user and psychologist, told the audience
how she has drawn up a list of her needs, wishes and expectations for
treatment when ill. When she becomes ill, her advocates sole task is
to ensure that this plan is implemented by the services responsible.
Here the advocates own views are very deliberately kept out of the
picture. The advocate is, as it were, merely an instrument for ensuring
that the partners views are respected at a time when they otherwise
might not be. Although the advocates skills will be important in
negotiating the plan with services, their relationship to the partner is
immaterial. They are speaking up, not necessarily because they know
her well (as a carer or relative might), but because the partners wishes
must be paramount. This is a powerful example of advocacy in action,
and it may be tempting to think that all advocacy could follow this
pattern. The evaluation of advocacy would then, exclusively, be a
matter of asking partners whether the advocate had succeeded in
getting their wishes implemented. But consider the following scenario:
Hassan has dementia. He lives in a residential home near to his elderly
sister, who visits regularly. Hassan has had a citizen advocate for six
months. Now, social services propose that Hassan be moved to a
nursing home further away, as this will offer more comprehensive
care as his condition deteriorates. But his sister will not be able to
visit him nearly so often. Hassan does not appear to understand the
proposal to move him.


A right result?

In this case there is no obvious answer for the advocate to pursue;

but this does not make the advocacy role any less vital. Hassan may
need to be defended against a move that suits the services needs
rather than his own. The value of his relationship with his sister may
need to be set against the clinical value of any proposed move. Hassan
may well need support and reassurance through a time of considerable
uncertainty. Any or all of these issues may require advocacy input.
The role will be complex, and evaluating it difficult. Whereas explicit
partner satisfaction was the sole criterion of the worth of advocacy in
the previous example, here its role may well be negligible. Hassan
may be able to say little or nothing about the advocate; he may not
even know whether the advocate is doing well. The latters role here
would have to be judged in terms of factors such as their values and
commitment, as well as the results these bring. Is the advocate doing
their utmost to see the situation through Hassans eyes? Do they have
a real commitment to him as a person? How is this commitment
shown in their actions? Far from being an impersonal instrument,
here it is the advocates personal qualities, and the quality of their
relationship with Hassan, which are the defining facts of the
So in some advocacy situations, user feedback will be central to
the evaluation of the support given. In other, equally important
scenarios, it will not be possible to gain this feedback, and a broader
spectrum of indicators will need to be used. These indicators are
unlikely to be part of the BestValue approach, which (in line with the
model in Figure 1) assumes that service organisations follow a single
series of processes in order to deliver outcomes. This cannot be the
case with advocacy.

The rationing agenda

In the section on the ambiguity of measurable outcomes, it was noted
that ANNETTE, in anticipating the BestValue approach to advocacy,
would be likely to give an advantage to schemes that could demonstrate
a high throughput of partners; in other words, schemes based on the
casework model. This can be taken a stage further. May not a Best
Value funder decide, not only that short-term advocacy is better than
the citizen advocacy approach, because of its higher outputs, but that
even short-term advocacy would be more efficient if it were timelimited? That is to say, every issue should be resolved, and every


Problems in measuring advocacy outcomes

partnership ended, within a given timescale. Indeed, the authors are

aware of at least one scheme which has to obtain its funders permission
if it wishes to work with an individual for more than a couple of
months. From the Best Value perspective, this is a logical step; from
the advocacy perspective, it is surely a fatal compromise of a schemes
independence. The two approaches are here irreconcilable.
The reasons for this conflict become clearer if we review some of
the agendas that lie behind Best Value. It was stated earlier that Best
Value grew out of the shift in industry and retail to a consistent and
pervasive focus on the needs of the customer. But there is one
important difference between retail consumers and the customers of
public services. When someone buys an insurance policy (to continue
our earlier example), they could be said to be an empowered customer,
since the insurer needs their premium as much as the customer needs
the cover. Should the customer require two, four or a dozen policies,
the insurer will be no less pleased with their custom quite the
opposite, in fact. In health and social services, however, the customers
are not so empowered; our need for help or treatment is not matched
by a corresponding need on the services part to help us. In fact,
given the limits to public finance, they often have an interest in
rationing the services they provide. To some extent, this interest is
counterbalanced by Patients Charters and other standards but the
rights contained in these documents are themselves defined by the
rationing bodies: the providers and the government. The point is
illustrated by the fact that even those who are generally confident
and assertive can quickly feel powerless and humiliated when they
receive poor healthcare, perhaps feeling the shock of being utterly
dependent on clinicians who have no corresponding need, or apparent
care, for them.
The reality of rationing means that in some respects, the BestValue
approach undermines the customer first ethos even as it apparently
promotes it. In importing the Best Value approach into advocacy,
there is a real danger of importing rationing, too. If this happens, one
of the key tasks of advocacy challenging the exclusion of individuals
from services is effectively neutered. Advocacy will have become
another rationed, and rationing, service.


A right result?

A middle way?
As things stand, then, the Best Value approach poses a number of
threats to the practice of independent advocacy. Nor are these threats
purely hypothetical; advocacy is already being influenced and, we
have argued, its principles weakened by the demands of Best Value.
The conflict which Wolfensberger and OBrien portrayed between
the service culture and the advocacy culture is as real as ever. The
terms of the conflict, however, have changed and become more subtle;
Best Value poses a threat to advocacy precisely because it seems to
have assimilated some key advocacy values, such as putting the
customer first. These apparent values tend to blur a reality that is
driven by outputs and rationing, making it all too easy for advocacy
to accommodate itself to issues it should be challenging.
But whatever the threats it poses, Best Value is here to stay: the
advocacy movement cannot simply opt out of its demands for
efficiency and demonstrable effectiveness, and still hope to attract
public funding. It will in future be less and less possible to attract
resources simply on the grounds that advocacy is worthwhile. Is
there a middle route between a wholesale capitulation to the service
model which betrays the purpose of advocacy, and a retreat into purist
isolationism which will see it wither on the vine as advocacy schemes
continue to argue over what exactly purity is? Such a middle way
may be possible if the advocacy movement can produce its own
account of what constitutes good advocacy; that is, if it can define
advocacy outcomes, and the means used to deliver, monitor and
evaluate them in terms which are credible to its users and to society
at large, and which are distinct from those of the service culture.
Achieving this would require much closer cooperation across the
advocacy movement than exists at present.
This chapter began with attempts to establish a baseline for current
advocacy provision. This task was complicated by the fact that, first,
there are apparently insoluble arguments between different schools
of advocacy which undermine the credibility of existing evaluation
systems, and second that advocacy is in danger of being distorted
rather than legitimised by the demands of Best Value. The chapters
conclusion has been that the advocacy movement must define itself
in a way that is both distinctive and coherent in order to overcome
these threats. This task of definition may best be begun by asking the
fundamental question What is advocacy for?



What is advocacy for?

Ask the question What is advocacy? and, as we have seen, one can
quickly become mired in the arguments between different styles of
advocacy. By asking what advocacy is for, we may be able to identify
a range of outcomes that cuts across these different styles. This in
turn may allow a refocusing of the advocacy movement around
common endeavours. What is advocacy for? seems a pertinent
question, too, because advocacy (unlike, say, befriending) by definition
aims at something beyond itself. Advocacy aims to bring about changes.
If we wish to develop a strong advocacy culture, we must present
these changes or results more clearly.
If advocacy means speaking up for another, it must involve integrity,
conviction and wholeheartedness. A key test of this integrity will be
whether the relationship with the other is in any way tainted by
vested interests. But this will not be the only indicator; the quality of
the advocates rapport with their partner, and of the tasks they
undertake on the partners behalf, will also be important factors.
Advocacy schemes of all types have tried to codify these and other
core values into principles which will regulate advocates activity. Yet
in reading almost any code of practice for advocates, one becomes
aware of quite intense conflicting pressures within the role. The
following, from a code of practice in the Key ideas on independent
advocacy pack (Advocacy 2000, 2000)1, is a good illustration of this:
An advocate has the right to speak up on any issue ... which the
advocate and their partner feel need attention.
The advocate will not do anything on their partners behalf without
first making every effort to be sure that their partner wants them to.
People with severe disabilities may not be able actually to speak and
say what they want, but no matter how severe the disability people
can usually find other ways of letting people know how they feel and
what they want. (Advocacy 2000, 2000, section 6, p 16)1


A right result?

There is a huge amount said, and still more implied within this relatively
brief quote, which is worth analysing. It opens with a statement
about the rights of an advocate to represent another. These rights
are considerable; they imply that the advocate speaks with authority
on the partners behalf and therefore should be heard. The image of
the advocate here is of someone who is likely to have a bold and
significant impact on the way services and society treat their partner.
The second statement places the advocate under an obligation that
is at least as great as their rights to follow their partners wishes at
all times. Indeed, they are to make strenuous efforts to find out what
these wishes are, however hard they are to identify. The image here is
of the advocate as always cautious; any understanding they have of
the partner may only be provisional. Is there a tension here between
one principle which encourages advocates to speak up for partners
because they have a special kind of commitment to (and even
responsibility for) them, and another which requires the advocate to
work in a highly self-critical way in order to achieve a dispassionate
view of what the partner really wants? The first principle asserts that
a strong identity between advocate and partner exists and is the basis
of advocacy. The advocate represents the partners wishes as though
they were their own (OBrien, 1987). The second principle is cautious,
even sceptical about such identification; the advocate must continually
check that their commitment is not obscuring the partners wishes.
Advocacy principles are meant to tell advocates how to put key
advocacy values into practice, but in this instance, two core principles
appear to be in tension, if not in conflict. Neither can be discarded,
since each is rooted in a value that lies at the heart of advocacy: on
the one hand, the need for advocates to identify with those they
speak up for, on the other, the need to respect the partners autonomy.
Instead of giving clear guidelines for action, the principles can in
some real-life situations present us with a dilemma. The following
story highlights this dilemma:


What is advocacy for?

Alice has been Janes citizen advocate for six months. Jane has a
severe learning disability. Her face lights up when she sees Alice, and
she likes showing Alice magazines and some of her treasured
possessions. She seems happy at home.
Recently, other residents have complained about Janes behaviour, and
it is now proposed to move her to a more supported environment
where she can be helped with her behaviour. Service staff tell Alice
they dont want to say too much too soon to Jane about the move
because she might get upset.

How should Alice proceed? Should she do everything she can to

find out Janes views, taking the risk that this will distress her without
necessarily finding out her informed opinion? Should Alice simply
challenge the decision to evict Jane from her home? Should she visit
the proposed home herself, to see if it looks as though it may be right
for Jane? She might do any of these, or pursue one of a number of
other possibilities. What is clear, however, is that the principles of
advocacy do not prescribe a single, simple course of action in this, nor
in many other instances:
Advocacy involves issues and problems which are not easily
resolved, and which may not have a right answer. People working
in advocacy need to be aware of this and have strategies to deal
with such problems. (Advocacy 2000, 2000, section 1, p 8)

A clear and coherent set of principles is essential to any advocacy

undertaking; the responsibilities involved in speaking for another
person in formal settings are far too great to be left to individual
whim. But the preceding paragraphs suggest that no set of principles
can satisfactorily dictate an advocates course of action in all
circumstances. There will be many situations where an advocate has
to rely on their own judgement; and this judgement will be informed
by the kind of relationship that exists between them and the advocacy
partner. Why should this be? One answer may be that there are two
conflicting currents or philosophies at work within advocacy, which
need to be described more fully if we are to understand what advocacy
is for.
There is a side to advocacy that has its roots in something other


A right result?

than principles and ideologies in what one might term the moral
drama of everyday life. The following story illustrates this point:
Peter and Joan
Peter and Joan are working in their office. Erroll, their manager, comes
in and starts to shout at Peter for delivering a piece of work late.
Peter tries to defend himself, saying that Erroll has not made clear
what he wanted, but his defence is met with a torrent of personal
criticism. Erroll tells him he is a disappointment to the company, far
less effective than person X in department Y, and the chief reason for
recent poor performance.
At this point Joan speaks up. I think you are being unfair. Peter asked
you for more information on this two weeks ago and you never got
back to him. Erroll is silenced and storms off. The crisis has been

The power of such events is immediately apparent. Joans speaking

up on behalf of Peter has probably changed relationships within the
office forever. Peter might have felt isolated by Errolls tactics, but
now feels he has an ally and is less likely to be picked on in future.
Erroll may feel he has to rethink his whole managerial approach.
Quite possibly, too, the event will have changed (if only a little) the
way each character feels about themselves. Joan may have realised for
the first time how much she dislikes power games. Peter may feel
valued and therefore more confident in himself.
So, even in a simple advocacy scenario like this, many things can be
happening, many changes taking place. But it is important to note,
too, what is absent from this situation: Joan does not work out how
she should respond from a set of principles or ideas. What happened
was spontaneous; that was why it was so powerful. Joan may
subsequently rationalise the event, and decide that she was protecting
Peters rights as an employee but the thought never entered her
head at the time. Should Joan have sought Peters permission before
speaking up for him? The question simply never arose; it has no part
in this drama.
If we follow this line of thinking, it is much easier to see why
relationships are central to effective advocacy. It is relationships that
generate drama; drama that changes relationships. Wolfensbergers
genius in developing citizen advocacy lay in the fact that he put this


What is advocacy for?

sort of dynamic at the heart of the form; the citizen advocates

relationship to the partner should begin to transform their other less
positive relationships. The citizen advocacy movement might find
new energy and inspiration if it researched, developed and celebrated
the idea of relationship (or partnership), and saw its principles as only
the means to sustain relationships, rather than as an end in themselves.
Peer advocacy and self-advocacy, too, could be said to share in the
idea of advocacy as drama. It is important to say here that drama
does not refer to play-acting or over-the-top postures; it refers to all
those real-life situations that can only be described in terms of actions
and relationships, rather than ideas. No doubt it was an appreciation
of the dramatic element in advocacy which led Wolfensberger and
OBrien to make the telling of partnership stories the primary means
for recording achievements in citizen advocacy. Both peer and selfadvocacy may be said to proceed likewise from a perception that any
given advocacy problem is likely to be a product of the much wider
social and political situation in which the advocacy partner or selfadvocate finds themselves. This situation is likely to consist of
predominantly unequal or limiting relationships which result in a
lack of opportunity, low expectations, and a sense of powerlessness.
The peer advocate in speaking up for a user of mental health services
is then not simply addressing a problem, but is also using their equality
with the partner to demand a different type of service culture. If the
peer advocate is successful, it will no longer be a case of the partner
having to conform to the service before they are deemed to be better;
the service will have to value the partner as they are, and work with
them in any treatment process. The self-advocate, similarly, is
transforming a situation in which they have been seen as an essentially
passive user of services into one where they are a key player in the
Each of these three styles of advocacy, then, sees advocacy as capable
of bringing about far-reaching changes in individuals circumstances,
status and self-perception. However, if drama can be transforming, it
can also be clichd, pretentious or boring. As we noted in the last
chapter, the fact that a scheme employs a set of processes to bring
about change is no guarantee that those changes are actually happening.
Citizen and peer advocacy schemes need to find credible ways of
ensuring and demonstrating the effectiveness of advocacy partnerships.
One or two more points need to be made about the dramatic
element in advocacy. The first is to note the fundamental importance
of what can happen when one human being identifies with another.


A right result?

What has been said so far suggests that many advocacy partners find
themselves in situations where negative factors continually reinforce
one another. Being viewed as different makes it much harder for
people to be understood. Partners are therefore much more likely to
be judged, and these judgements are likely to lead to overt or covert
forms of exclusion or segregation. Long-term experience of this
kind of negative cycle is likely to cause a great deal of pain. Where
this devaluing cycle includes the trauma of abuse or other forms of
harm, the pain will be so much the greater. In its extreme forms, this
hurt is likely to destroy an individuals self-esteem, impair their
relationships with others, and inhibit them from utilising such
opportunities as do come their way. Simone Weil wrote that in
affliction we lose the world (Wills, 1956, vol 1). To value someone
who is otherwise devalued, to believe someone who is otherwise
disbelieved, to stand by someone who is otherwise alone, may be a
powerful means to help them find the world again.
It is important to state at once that this is not an attempt to categorise
advocacy as therapy, or users of advocacy as victims or sufferers.
On the contrary, it is to suggest that anyone who is persistently exposed
to negative, harmful or inappropriate environments may go through
very deep experiences of hurt which cannot easily be communicated.
The advocacy relationship offers the genuine commitment of another
person who respects the partners potential and encourages them to
explore this in their own way and time. In doing so, advocacy can
provide a non-judgemental arena in which the past can begin to be
recovered, not as problem or illness, but as human experience.
The advocates identifying with their partner may touch on some
deep human issues. But again, in recognising the power in an advocacy
that arises spontaneously out of one persons genuine regard for
another, we must recognise the possibility of failure here, too. To
return to our original scenario: suppose Joan had simply stayed silent
when Erroll was attacking Peter? She might well have felt scared, or
unequal to the task. People are not always altruistic; they are rarely
heroic; and it is a fact that some advocacy partnerships founder because
the volunteer advocate cannot or will not stay the course. Equally,
some partnerships fail because the advocate, no matter how committed
or skilful, feels that they cannot get to know the partner, or understand
their wishes. There may be failures in advocacy which are the fault
of no one; but this does not make redundant the question about
whether or not individual partnerships and schemes are effective.
By considering advocacy as something that is first and foremost


What is advocacy for?

dramatic a happening rather than as something primarily to do

with ideas, we can begin to understand why it is potentially so powerful,
and why it may be difficult to codify in a series of rules. But this is
only half the story. Consider another scenario:
Mary has a speech impediment. She has been asked to provide a
witness statement in a civil court case. She feels strongly about the
case, and wishes to present her statement live in court, but fears she
will not be understood if she reads it herself. She asks her longstanding
neighbour, Jane, to read the statement for her. Jane agrees. She reads
the statement as planned, Mary thanks her, and Jane then leaves the
court while Mary remains to hear the outcome of the case.

This scenario is in many ways the opposite of the one described

earlier in the chapter. There, there was a real threat to Peters status as
an employee; by identifying with him, Joan challenged the patterns
and assumptions that gave rise to that threat. In this scenario, Mary
faces an obstacle rather than a threat; she knows what she wants to say
to the court, but needs help in saying it. Jane, in agreeing to read the
statement, is not identifying with Mary: were she to read the statement
as if the case affected her personally, the effect would be bizarre and
inappropriate. Jane leaves court after reading the statement; although
she is doubtless pleased to have helped Mary, her involvement does
not give her any particular investment in the wider outcome.
Janes advocacy for Mary is essentially non-dramatic; she is rather a
proxy who has a simple role within a clearly defined situation. There
is a similarity here with the account of advocacy given by Rachel
Perkins, quoted in the last chapter. Jane provides the means for Mary
to control the situation, whereas Joan speaks up for Peter because he
is (temporarily) powerless. Both scenarios involve advocacy, but they
highlight radically differing advocacy styles. Peter and Joans story,
which led on to a discussion of advocacy as drama, might be said to
represent personal advocacy, whereas the Mary and Jane scenario
epitomises technical advocacy. This distinction has some echoes of
Wolfensbergers identification of expressive and instrumental
advocacy roles. But whereas Wolfensberger saw these as
complementary aspects of the citizen advocacy approach (on the one
hand developing an empowering relationship with the partner, and


A right result?

on the other hand speaking up with or for them), personal and

technical advocacy each represent complete, and in some ways
contrasting, concepts of advocacy. The personal advocate may well
speak up for their partner, but their grounds for doing so will be very
different from those of the technical advocate.
The personal advocate is likely to act out of empathy with, or
concern for, the partner, born out of a personal commitment to them.
Almost certainly, the advocate will have sought the partners approval
for their action, but the idea of raising an issue is quite likely to have
come from the advocate themselves. In raising the issue, the advocate
is likely to be moved by an unconceptualised wish for fairness, decency
and respect for their partner. Technical advocacy aims at a particular
outcome, and therefore generally presupposes a partner who is able
to articulate this desired outcome. The advocate provides a series of
skills, but the process is essentially controlled by the partner.
To some extent, the distinction between technical and personal
advocacy is reflected in the differences between schemes which see
themselves as undertaking casework, and those which define advocacy
in terms of partnership. Schemes offering professional advocates would
be a prime example of the former, citizen advocacy schemes of the
latter. Schemes which provide volunteer advocates to support people
through particular issues may combine elements of both approaches.
By looking at the possible strengths and weaknesses of each model,
one can begin to identify some key advocacy outcomes.
The casework approach


Advocates probably
knowledgeable and skilled in
dealing with service system

Casework is not generally


The advocacy will more or less

conform to a uniform standard

Requires clear direction

from the user

Clear guidelines for user

control of the advocacy

May be identified as just

another service by users

Professionalism gains credibility

with service workers

May not help those who want

support, rather than choices

Relatively fast response times

Possibility of advocate burnout


What is advocacy for?

The partnership approach



Solidarity can transform

perceptions of the partner

Advocates skill/expertise is

Allows partners views to

develop and change

Standards may be harder to


Preventive effects

Varying credibility with the

service system

Escape from the service culture

Varying response times

Supports the person, not simply

promoting their wishes

If these suggestions are correct, it becomes apparent that neither

approach can lay claim to the full range of advocacy outcomes.
Casework may have little to offer someone who needs the support
and commitment of another person in order to begin to recover selfesteem; partnership may not be relevant to someone who knows
their own wishes but faces an acute problem with the authorities
which will require expert help in order to be resolved. It is not
possible to state that either the partnership or casework model is
best; this will depend on the situation of the advocacy partner.
This distinction between casework and partnership schemes, then,
has some correspondence to the difference between technical and
personal philosophies of advocacy. But the correspondence is not
absolute. Citizen advocates may well find themselves embarked on a
technical role, promoting their partners explicit wishes in the face of
indifference or obstruction. Caseworkers may find that they develop
a strong personal commitment to some of the users of their scheme
perhaps to those who make repeated use of advocacy.
It is important that all advocacy schemes reflect on the relative
emphasis that they place on these two contrasting philosophies. It is
easy to fall into the belief that advocacy is all about choices or all
about loyalty but each view has its pitfalls. Advocacy schemes need
to be aware that principles which serve some of their partners well
may be less helpful to others; they should guard against too narrow a
definition of what advocacy is for. As we saw in the last chapter, the
Best Value funding regime favours the technical/casework approach;


A right result?

advocacy that aims at support, prevention and personal development

is threatened. This is not just a threat to the future of citizen advocacy,
although it is here that the threat is most apparent; it is a threat to
advocacy as a whole. For even within casework advocacy, as we have
seen, the personal rapport between advocate and partner may be
essential to the success of the role. If this personal element does not
continue to be highlighted across all schemes, if people are only cases
to be processed, advocacy loses its rationale. People who are not
supported, protected from abuse or sustained in their development of
self-esteem may, as we have seen, become people who are too
disempowered or despairing to voice their wishes or direct their lives.
In this sense, the more tangible processes of technical advocacy depend
on the deeper objectives of personal advocacy being met. The
advocacy movement must remain alert enough to include both
philosophies, and the funding environment should permit each to
The personal and technical philosophies mark out two distinct,
but interdependent approaches to the question What is advocacy
for? Studying them has helped to begin to shape a list of advocacy
outcomes: for example, prevention and user control (or choice) were
mentioned in the analyses of casework and partnership. It may now
be helpful to have a suggested inventory of outcomes. These will, of
necessity, have to be fairly generalised; nonetheless they should provide
some indication of what it is that makes advocacy distinctive. The
following list of advocacy outcomes is a first try that will hopefully
form the basis for further discussion and refinement by others within
the advocacy movement:

Social development

Each of these outcomes needs describing more fully.


What is advocacy for?

To choose is to make a difference; it is also to make oneself different.
The myriad choices that most people make in the course of a day
influence and change the environment around them in more or less
subtle ways. But a persons choices, precisely because they are individual
to them, play a key role in shaping other peoples perceptions of who
that person is, too. We may warm or cool towards people according
to the type of music they choose to play, or clothes they choose to
wear, or behaviour they choose to exhibit. To choose is to begin to
act as a definite person, rather than merely existing as furniture in the
lives of others.
Many people seek advocacy support because their choices are
obstructed. A disabled person wishing to live at home may be told
that their support needs are too expensive and that they must accept
residential care instead. A looked after young person may feel that
their foster carers are stifling their development with petty house
rules. An older person who wishes to continue looking after their
own money may feel threatened by a friend or relative who seeks
receivership. In all of these instances, where the partners choice is
disregarded, their influence over key elements of their personal
environment is removed. Nor is there simply an external loss; people
who have had what are otherwise basic rights taken away from them
are likely to feel hurt, angry or worthless or a mixture of the three.
In taking up issues of choice, advocates may not simply be influencing
what happens; they may be challenging long-held assumptions on
the part of society, or helping individuals to maintain or recover a
sense of self-worth.
The greatest strength of technical advocacy is in promoting the
choices of partners who would otherwise not be heard. The following
story illustrates how effective this can be:
Andrew lives with foster-carers. He would like to join a youth club
trip to Paris, but both his carers and his social worker oppose the
Andrews advocate, Jim, contacts the social worker and repeats
Andrews wish.


A right result?

There are things you dont know about Andrew which might change
your view, says the social worker.
Its not my view, its Andrews wish, replies Jim. And I dont really
want to know any more about him than he is prepared to tell me
You saw his behaviour yesterday; no one could travel in that state.
He was upset because you told him he couldnt go. Anyway, why does
he have to earn the right to go; none of the other kids do. Hed
accept the same rules as them; anyone misbehaving is sent home.
Well ... he has no idea about money, the social worker continues.
Hes had no chance to learn with his current carers. Besides, I have
spoken to the youth leader and he would help Andrew to manage.
Even if I agree, his carers wont....
Im happy to talk to them, says Jim.

The anecdote illustrates some of the many obstacles that can be put
in the way of choice: professional secrets, character judgements, the
partners supposed inability, and the appeal to powerful others. It
also shows how an advocate who is focused on the partners choice
can use information, argument and tenacity to overcome these
obstacles. From first to last, the partners wish is kept centre stage.
On the other hand, people who have exper ienced
institutionalisation or other forms of chronic disadvantage, as we have
seen, seem sometimes to lose the ability to choose altogether. What
we have termed personal advocacy can play a significant part in
helping people to recover the sense of confidence and self-worth
which are the foundations on which choice is built, as Ernies story
When I do see him, just to see his face, how happy he is to see me
that alone you cant buy that! I am there for him. He cant
speak, and were trying to work on developing signs. I think from
years ago he just stopped talking. He was probably left to his own
devices and didnt find the need to talk. (Williams, 1998, p 45)

In Ernies case, identifying his choices is a very long-term affair. But

the citizen advocate remains motivated to help Ernie, sensing and


What is advocacy for?

respecting his potential. At present, Ernie does not express his

personality through choices; his personality is only expressed through
free and creative relationships such as that which he has established
with his advocate. In this scenario, only a personal advocacy approach
can be effective.
Perhaps the most fundamental of all choices is that between yes
and no. No in particular can be described as the first step in choosing
because it marks a refusal of others version of the world, of their
plans or wishes. Many of those who choose the support of an advocate
do so because they are involved in an unequal struggle, often with
the service system. There may be huge, unspoken, pressures to go
along with whatever doctors, social workers or housing officers decree.
Because advocates are outside of the service relationship, and not
expected to be grateful, they can express their partners disagreement
or refusal confidently and consistently.
It is often remarked that the simple introduction of an advocate to
an individual can have a significant, positive effect on the way services
treat them. Professionals may become more respectful of the partner,
more likely to offer choices than ready-made solutions. One reason
for this is that the very presence of an advocate raises the possibility of
an effective no to the system. This kind of effect is extremely difficult
to monitor or record; perhaps advocates could note whether their
partners are indeed offered choices once the advocate is involved, or
whether the solutions offered are demonstrably needs-led rather than
Another key area of choice concerns an individuals right to take
risks, even to make mistakes. In the past it was the institutional nature
of services which prevented service users from doing anything that
departed from the norms set by the regime. Some of these restrictions
have disappeared with the advent of independent living and care in
the community, but the culture of risk management threatens to create
further barriers. The pressures of risk management are perhaps most
acute in relation to child protection. Many disabled and learning
disabled parents have faced the prospect of having their children
removed by the local authority on the grounds that their disability
and/or living circumstances pose a risk to the childrens well-being.
The child protection system focuses absolutely on the interests of the
child; it is therefore essential that parents have recourse to advocacy
(if they want it) so that their wish to bring up their children is given
a full and fair hearing, and all feasible avenues for realising this wish
are explored. In many such instances, there will be a need for strong


A right result?

technical advocacy, negotiating skilfully with a range of agencies in

pursuit of the parents wishes. There may also be a need for personal
advocacy, supporting parents through a bleak and stressful time,
whatever the outcome.
Advocates help people to identify and express choices. More than
this, they seek to make their partners choices effective, even decisive.
The styles of advocacy used to pursue these ends will vary, as will the
means of monitoring their success; nonetheless choice remains a key
advocacy outcome.

The choices available to a person at any given time tend only to be as
good as their general life situation. Someone living in a hostel for
disabled people may have a considerable degree of choice and control
within that environment, and yet still lack both opportunity and
acceptance within the wider community. An individual living in this
situation may simply not know of the ways in which they could make
their life better. Advocacy plays a significant role, therefore, not only
in representing peoples choices, but also in providing the information
on which those choices can be based.
Both technical and personal advocacy have a role to play in creating
access though, here as elsewhere, the respective approaches are different
to the point of seeming contradictory. Perhaps the differences are
best illustrated through two scenarios.
Access: technical advocacy
Mark is a sessional worker with a professional advocacy scheme.
Rashid is a disabled man who lives in his own flat. Rashid has asked to
see Mark because he feels he is getting no support in developing his
quality of life. Mark asks Rashid about his current situation, and how
he would like this to develop. Would he like to work? How would he
like his social life to develop? And so on. He notes Rashids answers
and after the meeting researches local services and opportunities
which he thinks would most closely meet Rashids needs. He meets
Rashid again to find out which of these avenues he wishes to pursue.
Finally, he agrees with Rashid how he should put a case to the local
authority for the additional support hours Rashid will need to realise
his wishes.


What is advocacy for?

In this scenario, Mark plays a vital role in bringing information to

Rashid, which enables him to make concrete plans for developing his
life. But Mark is careful throughout not to impose his own views as
to how Rashid should act, nor to seek to influence his choices. The
whole point of the advocacy exercise is that it should be owned by
Rashid. It would perhaps be wrong to talk of an advocacy partnership
in this instance; Marks role is more that of facilitator than peer or
Access: personal advocacy
Mary is undergoing the latest in a long series of hospitalisations for
mental health problems. She is quiet and withdrawn, refusing to attend
occupational therapy. Some staff feel she is being deliberately
The citizen advocacy coordinator, Jane, has heard of Mary via a relative,
and asks if she can visit her. Her initial questions to Mary are met
with silence. Then Jane notices that Mary has a tape of an opera
beside her bed. She tells Mary: I know a woman who loves opera. I
think she would like to meet you. Could I bring her in sometime?.
Mary nods slightly.
Over the following weeks, Anna becomes Marys citizen advocate.
They listen to music together, and Mary makes the occasional comment.
When Marys section is due for renewal, Anna asks if she agrees to
this. Mary shakes her head, but does not answer Annas follow-up
questions about what she, Mary, would like to happen in the future.

Jane and Annas approach with Mary is almost the opposite of Marks
with Rashid. Whereas in the first scenario it was important that
Mark kept his personality out of the advocacy process, here Annas
character is essential to its success. In the second scenario, advocacy is
precisely about building a partnership; it is Marys personal relationship
with Anna, rather than any information that Anna brings which will
hopefully create a bridge to a better life for her. The advocacy
tasks that Anna performs for Mary (representing her at tribunal and
so on) will be informed by this relationship, as much as by any overt
choices Mary has made.
The two scenarios represent extremes of technical and personal
advocacy. In helping partners to access greater opportunity, advocacy


A right result?

schemes will be supporting people who may at different times need

both personal and technical advocacy support. The challenge for
schemes is first, to be aware of these different (perhaps conflicting)
needs, and then to utilise their resources to meet them. Within a
citizen advocacy scheme, this will mean ensuring that the advocate
really is the right person for their partner. How is this decision
made? Within a casework scheme it will mean ensuring that advocates
are skilled enough to offer different styles of support to different people.

A simple, working definition of justice would be: the full realisation
of a persons rights, and redress for any wrongs inflicted on them. The
quest for justice lies at the heart of advocacy; it is the recognition that
injustice can and often does occur that has brought organised advocacy
into being; it was the uncovering of abuse within long-stay hospitals
which led to the creation of the first citizen advocacy schemes in the
If there is a popular image of advocacy, it is probably of an advocate
pleading a partners cause within a meeting, tribunal or case conference,
convincing powerful individuals or organisations that they should
value the partner more highly, or treat them with greater fairness.
Angie is in her mid-20s, and has mild learning and physical disabilities.
She wished to attend her local college to undertake a BTEC course.
To do this she would need the provision of transport and personal
support while at college. Angies advocate, Irene, was brought in to
help her negotiate this provision. Both the college and the local
authority made offers of support which were not enough. When
Irene objected and asked how these offers had been calculated (there
appeared to have been no assessment of Angies needs) it was implied
that Angie should be grateful for whatever she was given. Irene
researched the legislation covering social services provision, and
Further Education Funding Council guidelines on the inclusion of
disabled students. When she relayed the results of her enquiries to
the college and local authority, much better levels of help were
promised, and Angie was able to start her course.


What is advocacy for?

This popular image stresses the more technical aspect of advocacy,

portraying the advocate as a skilled negotiator upholding the partners
wishes in a difficult or even hostile environment.
Angies story, like that of Andrew earlier in the chapter, highlights
some of the key ingredients which make technical advocacy successful:
Assertiveness. Irene and Angie were not bought off by the suggestion
they should be grateful for what was offered.
Knowledge. Being able to locate the relevant legislation and guidelines
helped Irene to put together a convincing argument.
Negotiating skills. Irene was able to show that the authorities initial
position was flawed, since no proper assessment had been made of
Angies needs.
Any advocacy scheme can and should ask itself how it helps its
advocates to develop these faculties.
Though technical advocacy skills will be to the fore in seeking
justice for partners, personal advocacy also has an important part to
play. As noted before, people who have experienced long-term
injustices (abuse, institutionalisation) will be far less likely to find their
way to an advocacy scheme, or to express clear-cut choices. There is
a vital role for advocacy schemes which can identify deeply
disadvantaged groups and individuals and create long-term advocacy
partnerships which will gradually raise partners expectations and the
standards of their services.
Speaking up for justice can be highly contentious; an advocate
who speaks up passionately for their partners cause may encounter
equally forceful opposition. It is far from unknown for advocates
who have challenged the status quo to have their integrity or
competence questioned. Such conflicts become even more complex
if the organisation being challenged (for example, a local authority) is
also the schemes main funder. There will quite possibly be pressure
on the scheme (spoken or unspoken) to tone down its advocacy or
face withdrawal of funding. While the present, unsatisfactory
arrangements for advocacy funding persist, a key part of any evaluation
must surely focus on how a scheme challenges its funder, and how
these challenges affect both individual partners, and the provision of
advocacy in general.


A right result?

Social development
Advocacy evaluation systems to date have failed to highlight advocacys
impact on the development of society at large. This is puzzling, given
that advocacy, if it has any meaning at all, consists of a series of live
encounters with issues of rights, disadvantage and justice. In laying
bare the unfairness or impracticality of rules and regulations, advocates
are demonstrating the need for these to be changed. As David Brandon
records (Brandon, 1995), MINDs advocacy in the early 1980s was
geared to just these sorts of outcomes.
Personal advocacy plays a part here, too. Citizen advocacy schemes
have always held that by valuing otherwise marginalised people,
advocacy demonstrates the possibility of a more inclusive, less
prejudiced society. Citizen advocacy partnerships make the point
that not every human need can (or indeed, should) be met by the
creation of a specialist service. Personal advocacy makes the case for,
and helps to build, a less compartmentalised society.
There is no easy measure of a schemes social impact, but the
following indicators may help to outline this. A scheme might ask
itself whether its advocacy has:

helped create, or widen access to, innovative, needs-led services

challenged and/or altered organisational procedures
attracted positive media coverage
helped people to gain independence as members of the community
challenged discrimination.

In looking at the differences between technical and personal advocacy,
we suggested that while technical advocacy aims primarily at the
realisation of the partners stated choices, personal advocacy can be a
source of long-term development and empowerment for people
whose wishes are, for whatever reason, unclear. An advocate whose
role is not time-limited, and who is there not as part of a service
intervention, but out of loyalty to their partner, can help that person
through the states of anger, despair and disorientation that may result
from trauma or ongoing hardship, to the point where they begin to
find the world again.


What is advocacy for?

Social services initiated proceedings to have Miriams child taken into
care, and then offered for adoption. Dee acted as Miriams advocate
throughout this process, helping her to liaise with her solicitor,
obtaining better support from social services, and finally going with
her to the court hearing. Miriam lost her case, and her child was
Dee continued to support Miriam through the difficult months that
followed. Shocked by her loss, Miriam first had thoughts of having
another child, then of harming herself. Dees loyalty and willingness
to listen helped her get through this period. Slowly, Miriam began to
plan for a more positive future.

It is sometimes argued that this sort of supportive role is just

befriending, and not really advocacy at all. Certainly, had Dee been
offering purely technical advocacy, her role would have ended with
the loss of the court case. This, however, would have left Miriam in
crisis. Instead, Dee was able to build on the relationship she had
developed with Miriam to offer her empathy and encouragement.
What had been, for Miriam, an entirely negative and depersonalising
encounter with the service culture began to be transformed into a
manageable, if profoundly sad, personal experience. Dees role was
not just befriending because where befriending is essentially aimless,
Dee had a clear goal: to help Miriam through a period of turmoil, to
the point where she could begin to make choices informed by hope
rather than anger.
If the advocacy movement gives up its role in supporting these
sorts of personal outcomes, it will lose much of its soul. There is
pressure for it to do just this. As we have seen, funders increasingly
are opting to support advocacy that is time-limited and task-driven.
The governments sponsorship of Patient Advocacy and Liaison Service
(PALS) within the NHS looks set to continue this trend; the confusion
of advocacy and liaison in the schemes title suggests that it may be as
much about improving the system (and thereby reducing litigation?)
as about supporting the patient. Of course, advocacy can help service
systems to work better, but this is not its rationale; it exists to promote
the value, interests and wishes of the individual.


A right result?

Empowerment, like advocacy itself, is widely acclaimed but difficult
to measure. This is not to deny that it is a genuine outcome of good
advocacy; and it is worth reflecting on some of the ways in which
advocacy promotes empowerment.
If empowerment is the growth of an individuals ability to direct
their own actions and influence their environment, then there are
strong links between empowerment and choice. If advocacy helps
someone to make a choice that was previously denied them (for
example, to change their accommodation), that person may in future
feel much more confident in voicing similar choices perhaps now
without an advocates support. Empowerment may therefore be a
long-term benefit accompanying more immediate advocacy
Individual empowerment may be particularly connected with the
development of self-advocacy skills. The growth of the self-advocacy
movement in the past decade has highlighted how effective people
with learning disabilities or mental health problems can be as
negotiators, organisers and campaigners. Mindful of these
achievements, advocacy schemes have often included a reminder of
the importance of self-advocacy in their codes of practice:
An independent professional advocate aims to support people to
represent their own interests where possible and very much as a
preference to acting on their behalf. (Advocacy 2000, 2000, Section
1, p 12)

Nonetheless, the issue of empowerment sometimes appears to be a

source of confusion or conflict between advocacy and self-advocacy
groups. A similar extract from Atkinson (1999) highlights this:
Advocacy takes many forms but is essentially about speaking up
wherever possible for oneself (self advocacy), but sometimes with
others (group or collective advocacy) and, where necessary, through
others. (Atkinson, 1999, p 5)

This passage can be read in two ways. If it is stating that advocacy

should begin with an affirmation of peoples abilities, rather than
assumptions about their disabilities, this is quite true. One sometimes
hears it said that every service user should have an advocate. Well-


What is advocacy for?

meant though such statements are, they reinforce the negative

perception of service users as needy recipients. No one should have
an advocate who does not want or need one. However, the Atkinson
quote can also be read as suggesting that any advocacy which is not
self-advocacy is by its very nature second best. This is misleading. All
of us benefit from others help at times; and throughout the course of
our life it is our relationships with others which tend to be the most
significant source of our personal development. To imply that those
who receive support from an advocate are doing something less valid
than those who advocate for themselves would be both untrue and
divisive. The empowerment that comes through successful advocacy
partnerships should be celebrated in the same way, and for the same
reasons, as self-advocacy.

By its nature, the prevention of harm, abuse or injustice is perhaps the
most difficult of all advocacy outcomes to measure. How does one
record something which has not happened and demonstrate that its
non-happening was the result of advocacy? Yet, time and again,
schemes find circumstantial evidence that the very presence of an
advocate seems to have led to an improvement in their partners
Perhaps it is the confidential nature of the relationship between
advocate and partner which is the key here. When an organisation
believes that it knows all about an individual, a terrible determinism
can creep into its dealings with that person. One sees this clearly in
the power of the labels that services apply to people labels such as
schizophrenic, challenging and so on; the person becomes
indistinguishable from their problem. It probably happens in less
obvious ways too: the person with profound learning disabilities who
is only ever seen in the routine settings of hostel, minibus and day
centre may be perceived as little more than the sum of the services
they receive. If such a person has an advocate, whose dealings with
them are confidential, there is at once something not known about
that person, a distance which commands respect. They are seen as a
person with interests; interests which do not necessarily coincide with
those of their service provider.
Despite the difficulties in measuring these sorts of effects, advocacy
schemes may be able to develop indicators which at least show that


A right result?

they are tackling issues of prevention seriously and systematically. A

scheme might record:
How it identifies people at risk such people are unlikely to find
their own way to a scheme.
What proactive steps does it take to find them, and what criteria
does it use to support this process?
How many people does it identify through this process?
What skills do advocates offer to vulnerable people, and how does
the scheme support and develop these skills?
How do advocates help people to avoid risk? For example, by

informing people of their rights

arranging legal support for partners

representing formal complaints

helping to report abuse

preventing financial exploitation

helping to foster high expectations

actively monitoring services.

Doubtless this list could be developed further. Schemes that can
offer a range of personal and technical advocacy approaches can play
a key role in protecting people from injustice and maltreatment.
This chapter has attempted to provide some answers to the question
What is advocacy for? It has suggested that there are two key sources
of advocacy. The first is bound up with the drama of ordinary human
relationships, one person supporting and speaking up for another out
of a concern that does not require a highly developed conceptual
base. This we termed personal advocacy. The second source is in
the much more specialised process of one person carrying through
anothers wishes in the face of physical or bureaucratic obstruction.
This was termed technical advocacy. Though these two sources are
contrasting, and may at times appear to conflict, neither can do without
the other. Good advocacy practice in part consists of managing the
tension between the two; knowing when personal advocacy is needed,
and when a more technical approach is required. We then proposed
a series of general outcomes which might describe the overall results
of effective advocacy.
If this, or a similar series of outcomes was acceptable to the advocacy
movement as a whole, it might form one foundation of what Atkinson
(1999) described as an advocacy culture. How this might further be


What is advocacy for?

developed, and what its implications could be, are the subject of the
next chapter.


The Key ideas pack draws on material from a range of schemes, but the views
represented in it are not necessarily those of Advocacy 2000.



Developing an advocacy culture

The last chapter proposed a series of general advocacy outcomes as

the foundation for what Atkinson (1999) termed an advocacy culture.
The present chapter will look at the ways in which this advocacy
culture can be developed. There are three key reasons for seeking to
do this:
The inadequacy of the service model. Chapter Three suggested that many
aspects of Best Value culture, such as its reliance on quantitative
indicators of success, are not only inappropriate for, but damaging to,
the implementation of good advocacy. In Chapter Four we saw that
the service model is particularly ill-suited to describing the practice
of personal advocacy advocacy which offers both support and
protection to the individual, and helps them to develop choices and
opportunities over a period of time. Hence there is a need for a
credible alternative model for advocacy practice.
Independence. Chapter Two highlighted the many ways in which the
independence of advocates and advocacy schemes may be threatened
or compromised. These threats will always exist as long as advocacy
has to operate in an environment the parameters of which are set, not
by the principles of advocacy, but by the requirements of service
organisations. If the practice of advocacy can be established as distinctive
and valuable in its own right, it will be far more difficult for nonadvocacy interests to influence, manipulate or control it.
Funding. Insecurity of funding is a further significant threat to advocacy
schemes. Most of the schemes spoken to in the course of preparing
this work cited it as a problem. An advocacy movement that is clear
about its identity will be much better placed to lobby for noncompromising and reliable sources of funding.


A right result?

One way forward may be to develop a general model for what happens
within an advocacy scheme. Like the outcomes proposed in the last
chapter, this model would need to be broad enough to cover the
many different types of advocacy scheme, but still sufficiently distinctive
to add something to the understanding of advocacy. Such a model
could help to ring-fence advocacy against further encroachment by
the service culture. It could also give helpful pointers for the
development of new schemes, and the strengthening of existing ones.
Aside from these pragmatic motives for trying to develop an
advocacy model, there is another, much simpler one: advocacy is
unique. Few other spheres of social activity can claim such a rich
combination of user involvement and personal commitment, or such
a wide range of outcomes. Perhaps the high levels of motivation
encountered among advocates and advocacy workers stem from the
fact that this remarkable array of resources is entirely focused on the
infinite possibilities of the individual. A strong advocacy scheme is a
cultural entity in its own right. Seen from this perspective, it can be
said that advocacy improves peoples access to, and experience of
services, not because it is a kind of super-service, but because it has
a wholly different kind of relationship with its users. Advocacy centres
on a unique type of relationship; and it is this relationship which
establishes the credibility and legitimacy of the advocates endeavours.
This relationship reflects not only the advocates encounter with the
partner, but the whole ethos of the advocacy scheme. This benign
view of advocacy can only be sustained, however, if within the advocacy
culture there are installed valid means for differentiating good and
bad advocacy. Distinctiveness cannot mean non-accountability; in
proposing a new model for advocacy processes we shall need to return
to the question of advocacy evaluation.
The model proposed is a model of the work of advocacy schemes,
rather than of individual advocacy partnerships. Whereas the service
model given in Chapter Three is built around the idea of a simple
intervention, or set of interventions, which is repeated with each
service user, no such simple, linear approach will truly portray the
diverse processes at work within advocacy partnerships. The outcomes
of advocacy are too varied to allow such a prescriptive approach.
Instead, we can try to develop a framework for advocacy schemes,
which will build on elements that many if not most schemes will
already take for granted, but which presents these elements in a way
which clarifies what is already happening, and encourages the
perception of common endeavours across the advocacy movement.


Developing an advocacy culture

Figure 2: A model for advocacy schemes







Three main considerations underpin the models relevance to the

advocacy movement:
It places values at the heart of the advocacy enterprise. More will
be said of this shortly.
Rather than focus exclusively on issues of ownership and principles
(as has often been the case in debates within the advocacy
movement) or on practice and outcomes (as tends to be the case
with the BestValue philosophy) the model seeks to present a broader,
more inclusive context for advocacy development.
Funding and funders are deliberately excluded from the process
model, in order to uphold the independence of advocacy. Funding
needs to be considered separately, and this is done towards the end
of this chapter.
Each aspect of the model now needs to be described in more detail.

Advocacy is values-driven: it begins with a vision, not with a series of
prescribed tasks. This vision is not uniform across the advocacy
movement, but within each scheme there is likely to be a set of strongly
held social ideals which will govern both what the scheme is trying to
achieve, and how it goes about this. We noted in Chapter Three that
there tends to be an overlap of aims and principles in advocacy. This
is borne out by the outcomes (or realised aims) listed at the end of
Chapter Four; at least three of these choice, justice and
empowerment are core values that will also determine how the


A right result?

scheme is run. Whereas, in business, values are subordinate to

outcomes, in advocacy, there is parity between the two.
The values-driven nature of advocacy is inescapable. For we have
seen that attempts to trim down advocacy, to make it fit better with
the service culture and Best Value ideals, lead to undue emphasis on
technical advocacy, and the neglect of significant areas of personal
disadvantage. This threatens to turn advocacy partners into
consumers. But if the idealistic nature of advocacy makes each
advocacy partnership potentially pioneering and exemplary, it also
carries the threat of complacency and tokenism. Just as we saw in
Chapter Three that the creation of a principled advocacy partnership
in no way ensures the success of that partnership, so it must be stated
that the adoption of a powerful set of values does not in itself
demonstrate that an advocacy scheme is worthwhile. The other stages
of the model will be needed to establish this. The model is, among
other things, a testing ground for the validity of advocacy values.

It is ownership of core values by a committed group often a steering
group or management committee which begins to turn aspirations
into realities. In recent years, the ownership of service organisations
has been a major issue for the disability movement. The notion that
disabled people must be looked after by non-disabled people who
know best has thankfully been eroded over the past two decades, to
the point where most major grant-giving bodies will now only make
awards to organisations which can demonstrate significant levels of
user-involvement in their management. Advocacy has not been
unaffected by this process. As Atkinson (1999) attests, there has been
some suspicion of the citizen advocacy form among disability groups,
who view it as perpetuating a stereotype of dependency. Both peer
and self-advocacy, in their different ways, seek to ensure that advocacy
is controlled by disabled people, and does not become another form
of exploitation.
Those involved with citizen advocacy would, however, oppose the
idea that it undermines or marginalises disabled people, founded as it
is on ideas of common citizenship and common humanity. It is worth
considering here this argument about control and ownership in
advocacy in a little more depth, since it highlights some of the
suspicions and misunderstandings that currently weaken the advocacy


Developing an advocacy culture

movement. In the first instance, it is important to distinguish the

ownership of a scheme (who manages it) from the control of its advocacy
processes (who instructs the advocate). Those who manage or own
an advocacy scheme are not there to bestow expertise on clients. In
advocacy, the client or partner is the expert, in the sense that it is their
values, priorities, needs and experiences which form the bedrock of
any given advocacy scenario. One might say that the advocates role
is to make the partners expertise visible and effective.
Sometimes this is a relatively straightforward process, as is the case
with technical advocacy scenarios. Here, as we have seen, the advocate
is directed by the users explicit wishes and conveys these to others.
But in many other situations, the partner does not instruct the
advocate in this obvious manner. An individual who is isolated or
institutionalised may have little concept of rights or choices, and it
may take weeks or months to develop a sufficient rapport with them
for their true wishes and interests to become apparent. Yet this personal
advocacy approach is still founded on the belief that the partner has
an expertise a unique and irreplaceable perspective which needs
to be fostered and respected. Thus here, too, it is the partners expertise
which directs the partnership.
So issues of ownership and control in advocacy are much more
complex than they may at first appear. Managing an advocacy scheme
is not about controlling the advocacy it provides, but about making
advocacy available to individuals in the way that will be most
empowering to them. It is to the credit of the citizen advocacy form
that it has always enshrined this principle. CAPE speaks approvingly,
for example, of
Advocates disagreeing with advocacy office staff about the nature
of a [partners] need, or the means to meet that need. (OBrein
and Wolfensberger, 1979, p 5)

The charge that citizen advocacy institutionally promotes dependency

cannot therefore be maintained; the partners needs should clearly
come before those of the scheme in a successful partnership. Of
course, there may be some individual citizen advocates who
misrepresent their partners, and it is important that schemes challenge
these advocates; but then failure is a possibility in all forms of advocacy.
There is probably no single ideal standard for the make-up of a
steering group or management committee; needs will differ from
one scheme, and one place, to another. What can be said is that the


A right result?

experiences of users of services are in one way or another fundamental

to the development of schemes. It is these experiences of injustice,
of empowerment, of exclusion overcome which bring a schemes
core values to life. Such experiences also highlight areas of advocacy
need. There are at least three ways in which schemes can be informed
by these experiences:
by including service users and representatives of other disadvantaged
groups in the schemes management, staff, and pool of advocates
by liaising with representative groups
by reflecting on the experiences of the schemes own advocacy
The ownership of schemes needs to be effective as well as
representative, however. Tasks such as management, recruitment,
monitoring and fundraising all require skill. While a scheme may not
include all desirable skills among its steering group at the outset, it
should surely work towards this. Indeed, there seems no reason why
evaluations of advocacy schemes should not look both at who is
represented on the steering group, and at the skills they possess. There
needs to be a balance between the two.
The issue of ownership also has a bearing on the comments made
in Chapter Two about the structural independence of schemes. There
it was noted that while some schemes are constituted in their own
right, others operate under the umbrella of a Council for Voluntary
Service (CVS) or are directly managed by national voluntary
organisations. A commitment to building a distinctive advocacy culture
does not appear to sit easily with the ownership of advocacy schemes
by non-advocacy organisations. Of course, there are exceptions to
this generalisation: where a group of people decides to start an advocacy
scheme, they may initially seek developmental and administrative
support from a CVS or voluntary organisation, until the project is
established. So there can be no absolute rule for how advocacy schemes
are managed.What can be said quite categorically, however, is this: to
the extent that the ownership and management of a scheme reflect
non-advocacy agendas, so far will the independence and quality of its
advocacy be compromised. Sometimes these conflicts of interest will
be blatant, as where an organisation runs an advocacy scheme and a
rehabilitation hostel for mental health users in the same area, but they
may also be subtle. Advocacy carries a good deal of credibility, and
the contract culture raises the prospect of what are essentially large


Developing an advocacy culture

service organisations buying in to advocacy in order to enhance

their brand value. Corporate culture and advocacy culture should
be kept well apart.

Who owns PALS?

The issue of ownership is especially pertinent to the governments
ideas for a new Patient Advocacy Liaison Service (PALS) for the NHS.
The government intends to abolish Community Health Councils
(CHCs) which have hitherto exercised a watchdog function in the
NHS, and instead require that all general hospitals should
accommodate a patient advocate, based in the hospitals reception
area and therefore accessible to all. The advocate will be employed by
the hospital trust.
It is encouraging to see advocacy, hitherto very much at the margin
of national and local government thinking, now suddenly thrust to
the top of the policy agenda in relation to the NHS. The fairly large
worm in this otherwise promising bud is, of course, the fact that the
advocacy will be owned by the very hospital trusts it exists to monitor
and to challenge. This will create considerable conflicts of interests. It
will be a remarkable advocate who can help a patient expose facts
that are damaging to the trusts public image; and it will be a remarkable
trust that does not seek to tone down an advocates potential impact
through control, manipulation or undermining. The compromised
ownership of PALS may have more direct impacts on the quality of
the advocacy they give, too. There is likely to be considerable demand
on PALS; advocates are therefore likely to find themselves under a
pressure of numbers scarcely less than that confronting doctors and
nurses. In this situation, will there not be a tendency for the advocacy
to be highly technical, concentrating on the processes of hospitalisation
(when will surgery happen? and so on) at the expense, for example,
of the patient who is too upset or confused to challenge their
consultants recommendations? PALS may challenge some of the
deficiencies of hospital systems; it is not clear that they will resolve
the very deep sense of disempowerment often felt by patients within
those systems.
It is not hard to see why the government should have chosen this
in-house model for PALS. The NHS is after all not just a provider of
health care. It is also a very large political football. In independent
hands, NHS advocacy might provide a rich mine of more or less


A right result?

sensational material for political opponents anxious to make political

capital, and for journalists. With regard to the NHS, it is perhaps hard
to say just who is independent. Nonetheless, the high profile adoption
of the PALS model hinders rather than helps the development of an
advocacy culture, since it gives a tacit nod to other large service
organisations which would be only too happy to create in-house
advocacy for their users, and to dispense with the rigours of
independent scrutiny.

Returning to the model, principles will dictate the kind of tasks an
advocacy scheme will undertake, and how it will undertake them.
The principles will reflect the schemes overall values, but will refer
directly to advocacy rather than to the wider social context. Principles
vary considerably from scheme to scheme, but the Key ideas identified
by Advocacy 2000 after widespread consultation with schemes in
Scotland provide a valuable summary:
There are lots of ways advocacy projects can be organised but
good ones will have these important ideas in common:
Inclusion and respect
Safeguarding quality
Advocacy dilemmas. (Advocacy 2000, 2000, section 1, p 8)

Again, there is a degree of overlap between principles and outcomes

(empowerment, inclusion); this as we have seen reflects the fact that
advocacy is about convictions. TheKey ideas form a potentially useful
benchmark for authentic advocacy, but they are abstract. How should
schemes determine the kind, or kinds, of advocacy they will practise?
Hitherto, this decision has tended either to be taken by schemes
themselves, on the grounds that one form of advocacy (citizen,
professional casework and so on) is the best, or else by funders who
feel that a particular form (usually casework) represents Best Value.
Can this process be refined, so that it incorporates not only conviction,
but also an attempt to analyse need?
The analysis of advocacy as incorporating both technical and


Developing an advocacy culture

personal approaches may be of help here. In the last chapter we set

out the key strengths and weaknesses of the technical/casework and
personal/partnership styles. If these suggestions are accurate, they
may help schemes to identify which style has most to offer the groups
they are working with. For example, if a scheme is working with
people who are generally self-sufficient, but face specific difficulties
or threats (asylum seekers, many users of community care services,
and some users of mental health services may be examples), then a
technical/casework approach is likely to be suitable. The partner can
tell the advocate how they would like the issue resolved, and the
advocate pursues this solution. If, on the other hand, the scheme is to
work with those whose lives are substantially directed by others, or
who experience ongoing disempowerment and alienation, a more
personal advocacy approach may be indicated, for example citizen or
certain kinds of peer advocacy.
Of course, the situation is rarely this straightforward. Personal and
technical advocacy needs very often exist side by side within user
groups, even within individuals. As we have suggested before, no one
form of advocacy can lay claim to the full range of outcomes; schemes
will need to consider whether and how they support people whose
needs lie beyond the schemes key strengths. For example, many citizen
advocacy schemes, though they are geared to supporting long-term
partnerships, have crisis advocates available. Similarly, a professional
casework scheme might employ or liaise with a counsellor to support
users who find it hard to identify choices. These efforts will be limited,
though, by the schemes need to focus on its core business.

Policies, training and practice

Policies determine the boundaries of a schemes practice. There are
good examples of advocacy scheme policies to be found in Citizen
advocacy:A powerful partnership (Wertheimer, 1998) and in Key ideas on
independent advocacy (Advocacy 2000, 2000). These cover such elements
as equal opportunities, confidentiality, and codes of practice for
advocates. Schemes may also require further policies, such as health
and safety and data protection, in order to comply with UK law. It is
important that these policies reflect accurately the distinctive nature
of a scheme. For example, a professional casework scheme which
supports people with respect to sensitive and complex issues is likely
to have a confidentiality policy which keeps all personal information


A right result?

strictly private. A citizen advocacy scheme, however, which aims to

bring the concerns of (partners) into the circles of ordinary
community life (quoted in Butler et al, 1988, p 3), may seek to strike
a balance between protecting sensitive information and encouraging
advocates to speak freely about their partners interests and concerns
with their family and friends.
Advocacy training is considered in detail in Chapter Seven.

Practice and credibility

Advocacy practice will be defined by all the preceding stages in the
model. The schemes management, principles and policies should all
be resources from which it can draw strength when its practice is
obstructed or challenged, as it almost inevitably will be. The processes
outlined in the first half of the model serve not only to make advocacy
happen, but to establish its credibility. Credibility is arguably an
advocacy schemes greatest resource, and one it should devote time
and energy to cultivating (see Atkinson, 1999, p 35). Credibility with
its user group is essential to a schemes legitimacy; credibility with
service providers is also vital, for if it is absent, advocates arguments
on behalf of partners are likely to be marginalised or rebuffed. A vital
part of advocacy practice lies in establishing the space in which good
advocacy can happen. How do schemes present themselves to service
providers in a way that promotes good communication, but is noncollusive? The information contained in Key ideas (Advocacy 2000,
2000, section 8) is useful in this regard, since it contains not only
guidelines for the relationship between advocates and service providers
(section 8.5), but also training materials to help get the message across.
Nonetheless, the relationship with service providers will be defined
as much by what happens in advocacy practice as by policies or
agreements. There will be times when advocacy offers a real challenge
to service providers, and these times may be politically difficult for
the scheme involved. The fallout from these confrontations can
perhaps be reduced if advocacy is also seen to reinforce and encourage
good practice wherever it exists. There are many committed, skilled
and empowering service workers; a balanced advocacy culture will
acknowledge their contribution.
On the basis of the above, we would reiterate our argument that
there is a place for the views of service providers in the evaluation of
advocacy schemes, albeit a limited one. Such evaluation could establish


Developing an advocacy culture

whether service providers understand the links between a schemes

principles, practice and outcomes; for if this understanding is absent
(and this may not be the fault of the scheme) the advocacy process
may be limited in its scope for success.
The practice of advocacy schemes is very diverse, and the suggested
model does not prescribe any one form as being better than another.
A little more needs to be said here, however, about the way advocacy
processes are owned by the advocacy partner. We have seen that this
issue of ownership highlights a key difference between technical and
personal advocacy. In technical advocacy, the process is owned by the
partner inasmuch as the advocate is simply an instrument for
implementing the partners wishes. Even where the advocate is
informing the partner of possible ways forward, the advocate is careful
to do this in an open, non-leading way. This sort of ownership can be
tested by asking the partner if the advocate has followed their
instructions. In personal advocacy, by contrast, it may precisely be the
case that the advocate is deliberately encouraging the partner to try
out new ideas and approaches, and shares in the experience of these.
Of course, if the partner declines a particular idea, the advocate will
respect this, but the advocates role is not primarily directed by the
partners instructions. Rather, direction emerges from the relationship
between advocate and partner; this empowers the partner to have
greater influence in their life. As stated before, the relationship between
advocate and partner is here not primarily about instruction or control
but like other dynamic relationships (say with family or friends) can
become the means by which a person establishes control over different
aspects of their life.
A threat to both these kinds of practice appears where schemes (or
more usually scheme funders) try to put a time limit around the
duration of advocacy partnerships. This is particularly a danger, perhaps,
in schemes using paid sessional workers, where the advocates time
represents a given cost outlay, but it is not unknown in volunteer
advocacy schemes. To have advocates racing against time to get a
result is likely to compromise even the most technically-minded of
schemes; there may not be time, for example, to explore all options
thoroughly with the partner. It is certainly incompatible with any
personal advocacy outcomes. The person-centred nature of advocacy
practice needs to be defended against attempts to turn it into cheap
care management.


A right result?

The individual nature of each piece of advocacy means that it is difficult
and perhaps inadvisable to monitor performance against rigid targets.
If, for example, a scheme is charged with creating a number of
partnerships in a year, it may be tempted to concentrate on easier
pieces of work and neglect partners who are more seriously
disadvantaged. Clearly, though, schemes need to be able to demonstrate
to their various stakeholders that regular, useful monitoring is taking
place. Though there will need to be indicators of outputs (the number
of partnerships or cases supported), this monitoring is likely to focus
primarily on what Key ideas refers to as safeguarding quality. Only
good advocacy practice can produce good outcomes; monitoring
should build as full a picture of practice as is possible, without being
intrusive. Below is a list of suggested areas for monitoring:
Monitoring advocacy: areas for consideration
Number of partnerships created/supported
Range of issues addressed by partnerships
Enquiries/identification of those needing advocacy
Waiting lists and times (where appropriate)

Partners satisfaction with advocacy
Partners aims
Risks to partners, advocates and staff
Vetting of new advocates
Equal opportunities
Support to advocates and partnerships


Developing an advocacy culture

Monitoring is not simply about collecting data: it is about

interpreting it so that a picture of the schemes current strengths and
weaknesses can be established and remedial action and/or new
development planned. Monitoring is therefore a lynchpin in
establishing and maintaining the schemes credibility. The issue of
monitoring, perhaps more than any other, lies behind the current
debate as to whether there could or should be national standards in
advocacy. The potential benefit of such standards would lie in
enhancing the credibility and profile of advocacy nationally, with the
possibility of safeguarding key principles and achieving consistent
funding. But there are objections both in principle and in practice.
On the one hand, some feel that the establishment of such standards
would undermine local ownership of advocacy; on the other hand,
the wide range of advocacy practices calls into question whether
agreement on standards could ever be achieved. The next chapter
will consider these issues in more detail.

Chapter Three highlighted some of the difficulties that currently
surround the definition and measurement of advocacy outcomes.
Chapter Four suggested that it is possible to define a group of general
outcomes for good advocacy. The section on Values earlier in this
chapter appears to confirm this conclusion; if advocacy begins with a
vision, it is surely fair to ask how far a scheme succeeds in realising
this vision. It may be argued that every advocacy partnership is
different, and that therefore it is not possible to talk of common
outcomes, but this is not so. The core values of advocacy schemes, the
beliefs in equality, opportunity, justice and empowerment, derive from
shared experiences and perceptions of inequality, disempowerment
and so on. It is therefore legitimate to look for common themes in
the individual results of a schemes work; for example, in what ways is
it helping people to achieve equality or empowerment?
How can schemes link what happens in individual partnerships to
the more general outcomes suggested in Chapter Four? It is important
to state at once that outcomes in advocacy should not only refer to
the final results of an advocacy partnership, as would be the case if
advocacy followed the service model outlined previously. Outcomes
refers more generally to the overall impact of advocacy partnerships,
to values realised as well as to tasks done. A long-term citizen advocacy


A right result?

partnership for instance may have many such outcomes over the
months or years of its duration.
James and Roy
Roy became James citizen advocate a few years ago. He introduced
James to his CB radio club, which James became very interested in.
This shared interest really cemented the partnership. James began to
tell Roy about his day centre, which he said he found boring, so Roy
helped him to ask if he could try some work experience. Then James
was rushed to hospital one day after collapsing. The hospital said
James hostel should provide most of his care on the ward, the hostel
said it was the hospitals job. Roy helped keep the two sides talking
until an agreement was reached that met James needs.

Roy has clearly made a number of significant differences in James

life. Even with short-term partnerships, advocacy may have an effect
which goes far beyond the issue on which the partner initially sought
help. It is important that these outcomes are identified and recorded
if schemes are to show that they are not merely principled, but also
How can this information be gleaned? Chapter Three discussed
the potential for and limitations to gaining feedback directly from
advocacy partners regarding the quality and outcomes of the advocacy
they receive. User feedback will perhaps be easier to gain where the
emphasis is on technical advocacy, and advocacy is the means to an
agreed end. In this sort of setting, questionnaires or face-to-face
interviews may help a scheme to gather valuable evidence for its
impact. This approach is likely to be less effective within the context
of personal advocacy, where to ask the partner to evaluate their
advocate would be like asking someone to evaluate a friend. Instead,
citizen advocacy schemes have developed the tradition of partnership
stories, where advocate, partner and (sometimes) the scheme
coordinator will reflect on the achievements of a partnership, and
record them in narrative form. These stories, as was noted in Chapter
Four, capture well the dramatic nature of personal advocacy, which
has a human, not a service relationship at its core. But the use of
anecdotes is not without difficulties in recording outcomes. First,
gathering stories is a time-consuming process; it is not practicable for
a scheme to tell the stories of all of its partnerships. Second, advocacy


Developing an advocacy culture

partnerships which touch on very sensitive issues are far less likely to
want to tell their stories, let alone see them printed in an annual
report, than those which are less difficult or intense. In (quite rightly)
protecting partners from prurience and sensationalism, schemes run
the risk of being left with partnership stories which seem unremarkable
or anodyne. A third way for schemes to identify outcomes is for
coordinators or managers to collate the information received through
monitoring. At Dorset Advocacy, information about the issues
addressed by advocacy partnerships is fed into a database. Every six
months, a table of partnership activity is produced, similar to that
suggested in the ANNETTE evaluation tool:
Measuring partnership activity
Development of interests
Control of finances
Health/medical care
Accommodation issues
Additional paid support
Education needs
Building outside friendships
Negotiating with services
Mental Health section/rehabilitation
Child protection
Personal relationships
Challenging behaviour
Legal advice
Communication help
Changing service philosophy
Criminal justice
Preventing abuse
Emotional support
Formal complaint
Monitoring services



A right result?

In this table, the figure beside each issue shows the number of
partnerships which have actively engaged with that issue in some
way during the monitoring period. The advocate may have helped
the partner to identify the issue, or to bring it to the attention of
service providers for the first time. They may have negotiated the
issue on the partners behalf, or have helped them to resolve or progress
it in some other way. Some partnerships may have addressed only
one issue during the period, other may have encountered as many as
six or eight. The total figure thus gives an idea of the overall level of
partnership activity.
The issues are of course not fixed, nor intended to be in any sense
a standard list; they can vary from one scheme to another, and from
one monitoring period to the next. This interpretation of ANNETTE
allows a presentation of the full range of partnerships, and of their
impact. Unlike ANNETTE in its original form, it does not bind
partnerships to a narrow process of goal achievement. Some outcomes
may be realised without ever having been identified as problems, for
example where a person with limited speech starts to communicate
more freely as a result of their advocates support and attention. The
table is, of course, entirely anonymous, and so avoids some of the
difficulties inherent in telling partnership stories.
There are, naturally enough, difficulties with this quantitative
approach, too. For one thing, it relies on the honesty of those collating
the figures (although this could be verified by independent audit).
For another, it gives only very limited qualitative information. Unlike
feedback from partners, or partnership stories, the figures do not show
the difference that advocacy has made to individual lives. There is no
single, simple way of recording advocacy outcomes. But the three
approaches described (partner feedback, partnership stories and records
of issues addressed) all have something to offer. In combination, they
can reveal a good deal about a schemes impact.
How do the specific advocacy issues given in the table relate to the
more general outcomes proposed in Chapter Four? This will be a
matter for interpretation by individual schemes. At the most basic
level, schemes might simply group individual issues under more general
outcomes headings, as below:


Developing an advocacy culture








service practices


Access to


Finding new

Access to law





Support in

Encouraging choice
/risk taking

abuse and


Promoting selfadvocacy

Help to make

independent living


The use of the seven headings already lends a more qualitative feel
to the issues listed. A more sophisticated method would be to use
these headings to interpret the qualitative feedback gained from partner
questionnaires or partnership stories. Joining up this material with
informed commentary, showing how different aspects of a schemes
work coalesce around a group of core outcomes, could be very

The theme of joining up carries over to the final aspect of the model:
evaluation. If advocacy is about values in action, then values, practice
and outcomes will all need to be scrutinised in a comprehensive
evaluation. This is a tall order. Hitherto, advocacy evaluation systems
have tended to focus on values at the expense of outcomes, or vice
versa. In proposing a series of general outcomes that is as distinctive
to advocacy as its principles, we are suggesting that it should be possible
to map an evaluatory path from first principles to outcomes along


A right result?

the lines of the model suggested. If this is correct, then evaluation of

advocacy schemes will not simply focus on the integrity of the different
stages described in the model, but will also consider the extent to
which all these stages are linked together to achieve the schemes
outcomes. The linking elements in the model (ownership, policies
and training, monitoring and evaluation) play a vital role in bringing
principles, practice and outcomes to life.
The future development of systems for evaluating advocacy schemes
will to some extent hinge on whether or not national standards are
adopted by the advocacy movement. Standards could provide a series
of benchmarks against which performance could be measured. This
could be particularly relevant to the evaluation of scheme principles;
as we have seen, there are enormous pressures to compromise within
the current funding environment. If core principles such as
independence, loyalty and equality were to be defined in terms of
non-negotiable standards, the integrity of advocacy schemes might
be considerably enhanced. But even if national standards are not
adopted, the model at Figure 2 together with the seven outcomes
could still provide the basis for evaluation. Here the evaluatory process
could give a descriptive account of a schemes strengths and weaknesses
in turning general aims into concrete outcomes, as well as of the
impact of those outcomes.
In effect, evaluation will demonstrate how far a scheme has
succeeded in creating an advocacy culture within its area of operation.
Has it upheld choice, and contributed to the development of a range
of appropriate services? Has it effectively challenged discrimination,
and enhanced the dignity of individuals? These considerations mean
that it is essential that any such evaluation system should speak to
audiences beyond, as well as within, the advocacy movement.
Evaluation provides an opportunity to get advocacy better understood
and more highly valued by interest groups, funders and society at
large. The opportunity should not be squandered.
Independent evaluation is expensive. The CAIT evaluation pack,
though designed to be cheaper than its predecessor CAPE, still costs
upwards of 2,000 per evaluation; it is clearly not something that
most schemes could afford more than once every five years or so.
Though this independent input is desirable, both to check the accuracy
of a schemes claims for its performance, and to provide an objective
overview, there is no reason why it should not be complemented by
exercises in self-evaluation, which could reduce the workload and
cost of the independent evaluators. Indeed, a complete evaluation


Developing an advocacy culture

system for schemes might include elements of external evaluation,

self-evaluation, and training for schemes to help them implement the
whole process correctly.

The model at Figure 2 tries to set out the parameters of an advocacy
culture and to create markers by which the success of advocacy
ventures may be judged. For reasons given above, funding does not
appear as a heading within the model; however, it has appeared
repeatedly in our discussions of the headings which do appear, just as
it was a recurring theme in the previous two chapters. This is therefore
a good time to review some of the ideas which have emerged in
relation to the funding of advocacy, and to develop them a little further.

Service providers as funders of advocacy

It is a paradoxical but inescapable fact that advocacy is as well established
as it is in the UK because of the resources it has received from service
provider and service purchaser organisations; in other words, from
local authorities and the NHS. Were these resources to be withdrawn
tomorrow, advocacy activity in the UK would be decimated; it is
highly unlikely that the National Lottery or trust sector could (or
would wish to) meet more than a fraction of the shortfall. For the
time being, then, the advocacy movement is likely to continue to be
dependent on service organisations for its funding.
The two huge drawbacks of this situation are, as we have seen, the
conflict of interest for schemes receiving money from organisations
they may need to challenge, and the increasing tendency of those
organisations to dictate the terms under which advocacy is to be
offered, thus undermining its principles.
The Best Value culture is here to stay, and the advocacy movement
must be alert to its demands. The last two chapters have tried to map
out the foundations of an advocacy culture which can proclaim its
own best value processes. Only thus can key advocacy principles be
safeguarded. There are some hopeful signs that such a culture can
take root even in the present funding climate. Several local authorities
have recently recruited advocacy commissioners whose task is to make


A right result?

sure that the funding of advocacy in their area is informed and effective,
as illustrated by this recent advertisement:
Joint commissioning manager: advocacy
You will continue to shape, co-ordinate and consolidate a structured
network of independent advocacy initiatives tailored to the
differing specialist and cultural needs of our customers. Your role
will be to lead the strategic and policy driven development of
advocacy, building on the existing network of advocacy initiatives
and utilising a wide range of the different forms of advocacy
available. (Job advertisement, Luton Borough Council, The
Guardian, 17 January 2001)

Even more significant in this respect is the Scottish Executives recently

published report Independent advocacy:A guide for commissioners (Scottish
Executive, 2000). This document recognises that a simplistic approach
to the funding of advocacy is inappropriate:
Traditional tendering processes are not a creative way to achieve
the effective provision of advocacy. (Scottish Executive, 2000,
p 23)

It recognises that different types of advocacy may be needed by

different groups in different situations (pp 21-3), rather than suggesting
that one model alone delivers Best Value. It is to be hoped that this
report will be widely read in England and Wales, as well as within its
home nation.
There are two key problems with putting advocacy funding out to
tender. First, unless very clear and detailed safeguards of advocacy
principles are written into the specification, the tender is likely to be
awarded to the organisation which does most advocacy for least cost.
As we saw in Chapter Three, this is likely to lead to the creation of
schemes which process people, but do not effectively support them.
Second, there is something a little too cosy in the idea of a local
authority choosing its own watchdog; the winning scheme may feel
it has to be tame in order to win next years bid. While tendering
may occasionally be unavoidable, the strategic, consultative approach
described in the Luton advertisement and in the Scottish Guide is in
general much more likely to deliver good advocacy.


Developing an advocacy culture

Services as providers of advocacy

In the section of this chapter on scheme ownership, we noted the
difficulties that can arise when advocacy is managed by organisations
whose core business lies elsewhere. Although this argument was
qualified, and recognition given to the skills and structural support
that larger organisations can bring, it is nonetheless desirable that
priority for funding be given to advocacy only organisations, all other
considerations being equal. This will help to reduce conflicts of interest
and give a clearer definition to the concept of advocacy. A corollary
to this is the suggestion that advocacy schemes should consider carefully
whether it is helpful to style themselves services at all. On the one
hand, the term invites the assumption that advocacy can be bought,
delivered and evaluated like any other community care service; this
report has sought to demonstrate that it cannot. On the other hand,
referring to advocacy as a service risks reducing it to the status of
mere trouble-shooting, since personal advocacy one persons
commitment to another is incompatible with the service approach.
There is a real danger that the supportive, empowering and
developmental aspects of advocacy will be lost here.

A long-term settlement?
Even if the more enlightened advocacy funding policies outlined above
gain ground, there will be enduring conflicts and tensions in local
and health authority funding of advocacy. Are there any prospects for
change here? Much will depend on the success of the advocacy
movement in raising its profile and credibility at a national level. The
recent government White Paper for England and Wales Valuing people
(DoH, 2001) may have a significant impact. It promises the
development of a National Citizen Advocacy Network (NCAN) to
strengthen advocacy infrastructure and to channel new money from
central government to local advocacy schemes. If this network proves
to be a credible voice for advocacy and a sustainable source of funding,
it will have gone a long way to solving two of the most intractable
problems besetting the advocacy movement.
However, there is still a long way to go. The funds to be channelled
through the national network are relatively small, and it is clear that
the government envisages a continuing and even an augmented role


A right result?

for local authorities as the funders of advocacy. There will be local

government performance indicators showing:
... the amount spent by each council on advocacy expressed as the
amount per head of people with learning disabilities known to
the council. (DoH, 2001, p 124)

The potential for destructive conflicts of interest in the funding of

advocacy will therefore persist unless either NCAN develops an
expanded role and becomes the primary route for advocacy funding,
or else at the very least issues clear standards to local authority funders
of advocacy which will limit the potential for such conflicts in practice.
This chapter has sought to map out the foundations of a distinctive
advocacy culture, and to look at some familiar debates within this
new framework. In particular, it has suggested ways in which advocacy
can sustain its independence, while still giving assurances on quality
to the world at large. One quality issue remains outstanding: the
question of national standards. It is with this question that the next
chapter is concerned.



Looking at standards

In the last chapter we looked at the possibilities for developing an

advocacy culture, and discussed some of the benefits this might bring
in terms of raising the profile of advocacy, supporting good practice,
and defending its core principles. This chapter will ask what role, if
any, national standards should play in underpinning this culture and,
if standards are desirable, who might develop them.
A standard can be defined as:
A definite level of excellence or adequacy required. (Chambers
English Dictionary, 1988)

There has been long-standing debate in the advocacy movement as

to whether standards are relevant to advocacy. The arguments in favour
of national standards can be summarised as follows:
National advocacy standards?


Standards would define and

protect key advocacy principles

National standards would

undermine local ownership

Standards would strengthen the

identity of the advocacy movement

Standards would drive out

flexibility and innovation

Standards would promote

quality assurance

Standards would
undermine personal advocacy

Standards would be an
aid to evaluation


A right result?

Standards would define and protect key advocacy principles. A key theme
of this book has been that independent advocacy is being
undermined by the imposition of a service culture. National
standards could help to ring-fence advocacy.
Standards would strengthen the identity of the advocacy movement. At
present, there are no hard and fast rules for determining what is
and what is not advocacy. Standards here might prevent the term
being so widely applied as to be meaningless, and could give a
greater focus to advocacy networks.
Standards would promote quality assurance. Adherence to quality
standards may help schemes to gain users confidence. Quality
standards may also protect especially vulnerable partners, and reduce
schemes exposure to complaint or litigation. Finally, such standards
may be helpful in persuading funders of a schemes integrity.
Standards would be an aid to evaluation. Having at least some uniform
measures of performance could help to establish a baseline for
evaluation. Though Chapter Three criticised the potentially
competitive implications of ANNETTE, this is not to say that all
comparison between schemes is wrong.
The counter-arguments include the following:
National standards would undermine local ownership. There is a fear
that standards would lead to uniformity, with locally appropriate
schemes being pushed out by a more corporate approach.
Standards would drive out flexibility and innovation. The advocacy
movement is still developing rapidly; volunteer advocacy, for
instance, barely existed as a separate concept five years ago. National
standards might make practice rigid and incapable of adapting to
future needs.
Standards would undermine personal advocacy. Having performance
standards which advocates must meet, would define them as part
of a service; this would conflict with an advocacy that is rooted in
personal loyalty, such as citizen advocacy.
Each of the arguments for and against advocacy standards is credible.
Do they then cancel each other out? We would argue they do not.
The preceding chapters have sought to convey the magnitude of the
threats facing independent advocacy at the present time, and have
argued that only positive and coherent action by the advocacy
movement can alleviate these dangers. The status quo, under which


Looking at standards

the question of standards is left to hang in the air, is not an option;

indeed, it is part of the problem. Just as it was suggested in Chapter
Three that the absence of authoritative models for evaluation created
a vacuum which is being filled by the demands of funders, so the
same holds true of standards. If the advocacy movement does not
generate its own standards, it is quite possible that these will be imposed,
locally or nationally, as a condition of future funding.
If the advocacy movement decides against adopting national
standards, by what other means could it defend its principles and
identity? It might be argued that advocacy could survive simply as
part of the wider disability rights movement. As an activity owned
and defined by disabled people and other service users, it could be
argued, advocacy would not need any external guidelines. Advocacy
would then be just one tool in a wider campaign for equality and
empowerment. Such an argument is attractive; this approach would
seem at least to ensure the independence of advocacy. However, it
has a major flaw. As we saw in Chapter Five, there is a vital distinction
to be made between the ownership of an advocacy scheme and the
control of individual advocacy processes. Creating the conditions
under which individual partners, or partnerships, really control the
advocacy process requires not only good scheme ownership, but also
good principles and practice. In trying to define the latter, we are
brought back once again to the question of standards. Though
advocacy should be informed and inspired by the experiences of
disabled people and by disability issues, ownership does not resolve
the issue of standards.
It seems, then, that the advocacy movement may have no other
option than to develop some core standards if it wishes advocacy to
continue as a distinct and meaningful activity. If, as we have argued,
the greatest threat to advocacy comes from pressures to compromise
its principles, then it is in relation to principles that national standards
would be most helpful. The main obstacles to creating such standards
The difficulty in achieving agreement across the many different
types of advocacy scheme.
The need to avoid the potentially negative effects of national
standards mentioned in the arguments against.
The question of which agency or agencies should be responsible
for the implementation and monitoring of standards.


A right result?

The third obstacle will be addressed a little later in the chapter. Taking
the first two together, it is clear that if there are to be any standards
which can be applied to advocacy as a whole, they will need to be
few in number and tolerant of different approaches. In other words,
they will be minimum standards; they will not prescribe how advocacy
should be delivered, rather they will seek to define a threshold beneath
which advocacy ceases to be acceptable; beneath which, indeed, it
ceases to be advocacy.

How might such standards be developed?

The task of consulting across the advocacy movement would be a
huge one; and, as we have suggested, there would be no guarantee of
reaching a workable agreement. However, in Scotland, Advocacy
2000 did undertake just such an extensive consultation in developing
the Key ideas pack (Advocacy 2000, 2000). In the last chapter we
discussed the ways in which the six core principles, or key ideas which
the pack identifies, could contribute to defining an autonomous
advocacy culture. Might it be possible to write standards against all,
or at least some, of these principles, so that they represent not merely
a description of current good practice, but also clear boundaries for
future advocacy developments?
We can try out the idea of standards by considering the first, and in
many ways the most important, of the six Key ideas: independence.
The principle is described as follows:
Independence: There should be no conflicting interests which
limit the actions of advocate and project. (Advocacy 2000, 2000,
section 1, p 8)

The principle is unarguable; but it does not, by itself, say what the
possible conflicts of interest are, or what constitutes a limitation of
an advocates actions. Should all forms of local or health authority
funding for advocacy be avoided, as the citizen advocacy program
evaluation (CAPE) seems to imply? Or (at the other extreme) could
a freelance advocate who is spot purchased by social services to work
with a service user on a fixed term basis in fact be perfectly acceptable
under this principle? Without standards, the principle is hard to define
or defend.
In the box below are suggested six standards for independence


Looking at standards

Standards for independence

1. An advocate must not be in the employment of a service received
by their advocacy partner. Neither should an advocate have any
other ties or loyalties to such a service.
2. An advocacy scheme may not be managed by an organisation that
provides or purchases community care services within the area
of the schemes operation.
3. Representatives of local community care purchasers/providers
shall not have voting rights in the management of an advocacy
scheme, except during its first two years of operation.
4. Funding agreements for advocacy schemes may specify the models
of advocacy to be offered, the groups to whom it may be offered,
and additional general indicators of advocacy need. Funders should
not stipulate or control the duration of advocacy partnerships,
the means of referral, or the decision as to which individuals should
or should not receive advocacy.
5. Evaluation will ideally follow an established advocacy model; where
this is not the case, the terms of the evaluation should be
negotiated between the scheme and its funder.
6. There should be a presumption in favour of organisations whose
sole work is advocacy, or which offer only free advice,
representation and informal support.

that might allow a clear and consistent understanding of the terms

advocate and advocacy scheme.
The first of these suggested standards should be self-evident;
someone who is part of a service cannot be relied on to challenge
that service on behalf of another. They will have an inner conflict of
loyalties, and may additionally face pressure from the services
management. Precisely the same reasoning lies behind the second
standard; advocacy organisations can no more be part of a wider service
system than can individual advocates, or they will experience the
same conflicting pressures. There may be some debate as to what
exactly constitutes a community care service, but on any
interpretation of the term providers of local residential, day, domiciliary
or healthcare services would be excluded from the provision of
advocacy. The third standard seeks to strike a balance between


A right result?

safeguarding the independence of advocacy, and recognising that

individual service workers have often played a key part in helping to
launch new schemes. It is unrealistic to expect every advocacy scheme
to be fully independent from day one; service representatives may be
a good point of contact for management skills or funding bids.
However, once a scheme is established, there are no grounds for leaving
any managerial powers with such representatives; they should never,
in any case, form the majority on a management committee.
The fourth standard also seeks to strike a balance between the legitimate
aim of offering appropriate types of advocacy to those most in need,
and the danger that such targeting may become a covert means of
controlling the advocacy process itself. In particular, the practice of
setting a time limit to advocacy roles appears entirely incompatible
with independent action on behalf of the individual. If a problem is
worth taking up in the first place, it is also worth seeing through to the
end whenever the end may be. This is not to say that all advocacy
roles should be long term; within a casework-type scheme, issues may
indeed be resolved within a short period, and the advocates role then
ends; but it is the issue which dictates the timescale, not vice versa.
The fifth standard seeks to ensure that advocacy is not evaluated
according to inappropriate models which may distort both its processes
and outcomes. Although advocacy evaluation systems have hitherto
tended to focus on the citizen advocacy model, the new Advocacy
2000 evaluation pack aims to be applicable to a wide range of schemes,
and other broadly-based systems may follow. Achieving widespread
recognition and acceptance for one or more of these evaluation systems
should be a high priority for the advocacy movement; only when the
evaluation is seen as credible are a schemes outcomes likely to be
perceived as authentic. There may still be times, however, when no
established programme of evaluation really fits a schemes
circumstances. In developing a one-off evaluation appropriate for
these circumstances, it is important that the terms and criteria are
agreed by both the scheme and its funder, and not simply imposed by
the latter without regard for advocacy principles.
The sixth and final standard might prove the most controversial of
all. The second standard does not preclude the possibility that an
organisation which provides community care services in one area
could provide advocacy in another (and this is, in fact, what happens
with several national voluntary organisations). However, the final
standard suggests a preference for structurally independent advocacy
schemes, in the belief that independent advocacy is more likely to


Looking at standards

flourish in such a setting. The principle here is not absolute; in some

settings the most effective advocacy may be delivered via a large
organisation, but here there should be an aim to achieve structural
independence for the advocacy scheme within, say, two years. The
standard should not inhibit minority ethnic or campaigning groups
from developing advocacy. Many groups which offer peer support
to, say, disabled people or to people from minority ethnic communities
find that an advocacy project complements their work in giving advice,
offering support and raising public awareness. There does not seem
to be any major conflict of interest here, so long as the group is not
also providing care or other paid-for services.
The authors are aware that many good advocacy schemes will not
currently be working to all the above standards; indeed, the authors
own schemes do not meet all of them. In particular, there may be
many schemes which form part of larger voluntary organisations
providing advocacy that is both credible and effective but would not
meet the sixth standard. At this first stage, it needs to be stressed that
the standards outlined above are not intended as a means for judging
individual schemes as good or bad; they are intended to demonstrate
a means by which the advocacy movement could hold the line on
the principle of independence. Were these or similar standards to be
adopted (after widespread consultation), schemes may have to adapt
or reorganise to meet them, but if the end result were a clearer and
more sustainable definition of independent advocacy, such changes
would surely be worthwhile.
Would these hypothetical standards avoid the dangers foreseen by
those who argue against national standards? We believe they would.
Instead of undermining local ownership of advocacy, standards 2, 3
and 6 would help to defend this by making it more difficult for
providers of care to provide advocacy also. Nor would these standards
limit the creativity of schemes, since they do not stipulate how
advocacy should be provided. Finally, standard 4, by making the
duration of the advocacy process a matter solely for the partner and
scheme to agree, asserts the validity of open-ended advocacy
partnerships as envisaged in the citizen advocacy model. Standards
for independence, then, may have much to offer the advocacy
These are only core minimum standards, intended to be applicable
across all forms of advocacy. Within individual schemes, these core
standards may, of course, be complemented by others relating to the
particular model of advocacy followed by the scheme; this theme will


A right result?

be developed later in the chapter. Could similar national standards

be devised for the other Key ideas? One of these,Advocacy dilemmas
clearly could not be supported by standards, since it refers to problems
which are not easily resolved, and which may not have a right answer.
(Advocacy 2000, 2000, section 1, p 8).
Of the others,Inclusion and respect,Empowerment and Loyalty
all have to do with the process of advocacy, rather than its status. They
can, therefore, for the purposes of this discussion, be considered under
the more general heading of the fifth principle,Safeguarding quality.
The question of national quality standards in advocacy, even more
than the question of standards for independence, is likely to raise
fears about advocacy becoming a uniform, bureaucratic and soulless
exercise. It is therefore worth considering some of the arguments for
quality standards, to see if they stand up to scrutiny:
Quality standards would increase customer confidence in advocacy schemes.
This is the argument for standards which is perhaps most frequently
encountered in retail and service cultures, but it is probably not that
relevant to advocacy. Most people who use advocacy are hardly in a
position to shop around for it. What helps people put their trust in
an advocate is the fact that the advocate is unambiguously on their
side not the fact that they have a Charter Mark.
Quality standards would support independent evaluation. This is true, though
as we have suggested, evaluation needs to cover every aspect of a
schemes life.
Quality standards would make advocacy more attractive to funders. Though
what is attractive is not always what is right, it does not seem
unreasonable for funders to want to be assured that the schemes they
are funding will meet some basic quality thresholds. If the advocacy
movement as a whole wishes to assert standards for independence, as
suggested above, those who commission advocacy are likely to demand
quality standards in return.
Quality standards would help to safeguard the interests of vulnerable people.
If it is acknowledged that some people who receive advocacy are
extremely vulnerable, then schemes have a duty at the very least to
try to ensure that this vulnerability is not exploited or increased by
advocacy. There is an obligation, too, to ensure that advocates are not
put at unnecessary risk.


Looking at standards

There are grounds, then, for trying to develop some quality standards
for advocacy, so long as these are rooted in an overall advocacy culture
and do not reflect non-advocacy agendas. Could such standards be
agreed nationally so as to embrace all advocacy schemes? A major
obstacle here lies in the very different ways in which the personal and
technical advocacy styles are implemented. A key premise of citizen
advocacy is that advocacy partnerships should be autonomous. The
scheme does not direct or control partnerships; were it to do so, it
would be imposing its own interests over and above those of the
partner. This concern dictates the attitude to quality standards; each
partnership is different, and it is up to the advocate and partner together
to work out what constitutes good advocacy for the partners situation.
Citizen advocacy schemes do not formally supervise advocates or
review partnerships, because this would imply that the scheme was
the ultimate owner of the advocacy.
Technical advocacy appears more amenable to what might be
termed service standards. In a casework scheme, using professional
advocates, advocacy is something that is provided by the scheme as a
whole, usually through a system of line management. At each level of
the management structure, there will be given responsibilities, for
which standards might be set. For example, such a scheme might
undertake to provide the first meeting with an advocate within so
many days of receiving a partners enquiry; advocates might be required
to take up issues with the relevant service provider within so many
days of this first meeting, and so on.
Given that this approach differs significantly from that of personal
advocacy, can any common standards be developed?A useful
preliminary step here may be to establish a framework for common
standards; that is, to define the kinds of themes that minimum standards
might cover. By identifying core areas of advocacy practice, we can
ensure that any standards which may be developed are at least relevant,
rather than merely arbitrary. Six areas suggest themselves.
Access to advocacy. It seems reasonable to require that schemes should
be both fair in deciding who they can and cannot support, and effective
in reaching out to a representative cross-section of their chosen client
group(s). This, like all other advocacy standards, will be qualitative
rather than quantitative. It should also be stated that there will never
be a financial charge for advocacy.


A right result?

Applying quality standards in advocacy

Access to advocacy
Advocate preparation
Advocacy processes
Coping with risk
Advocacy outcomes

Advocate preparation. Casework schemes will generally train their

advocates to a certain level of skill and knowledge, in order that they
can respond competently to a range of needs. Citizen advocacy
schemes tend to avoid formal training, believing that the key to
effective advocacy lies in the quality of the relationship between partner
and advocate. On either view, however, one can ask: what steps are
taken to ensure that the advocate is suitable and competent for their
Advocacy processes. Here again, the differences between personal and
technical advocacy are significant but not irreconcilable. Within a
casework setting, there might be standards determining the speed of
response to enquiries (as we have seen) or how an advocate agrees
aims with the partner. Within citizen advocacy, partnerships cannot
be standardised in this way, but there are nonetheless boundaries for
advocates conduct, such as are set out in various codes of practice for
Coping with risk. This necessarily will involve the undertaking of risk
assessments that may require the input of non-advocacy professionals
with the relevant risk management experience. In all the advocacy
forms, it may be tempting to play down the elements of potential risk
(to both advocates and partners) in order to appear informal and
user-friendly, but standards in this area may well help to safeguard
people against bad practice.
Advocacy outcomes. Within casework schemes, standards for advocacy
outcomes might imply some sort of mechanism for ensuring that the
partner is satisfied with the results of the advocacy input. Within


Looking at standards

citizen advocacy, such a mechanism would not be appropriate, for

here partnerships are not necessarily aimed at discrete results. Rather,
the partnership itself is the outcome, a creative and continuing source
of benefit in the partners life if it is working well. It is this if that
citizen advocacy schemes can and should monitor. While it may not
be possible to define standard indicators of a good citizen advocacy
partnership, there are any number of signs which can show whether
a partnership is succeeding or not. Citizen advocacy schemes should
have mechanisms which demonstrate that they are alert to the
difference between successful and unsuccessful partnerships.
Complaints. Advocacy not infrequently involves highlighting the
failures and shortcomings of care and other services. Schemes should
be able to demonstrate that they, too, are open to fair challenge and
constructive criticism. Anyone who feels they have been wronged by
an advocate or by a scheme should have access to a complaints
So quality standards seem possible in respect of these six areas of
practice, even if the precise content of the standards will vary according
to the model of advocacy followed. One might go a step further, and
say that this framework could be cast in the form of outline standards,
the detail of which individual schemes might complete, as follows:
Outline quality standards
Every scheme should record and monitor the advocacy needs of
partners, in order to ensure equality and diversity of advocacy provision.
Every scheme should have mechanisms for ensuring that advocates
act according to the wishes of, or out of a unique loyalty to, the
advocacy partner. (Preparation/process)
Every scheme should have a written policy on confidentiality. (Process)
Every scheme should have mechanisms for identifying risks to partners,
advocates and staff, and procedures for minimising these. (Risk)
Every scheme should have written procedures for meeting advocacy
needs, and for monitoring how far they are being met. (Outcomes)
Every scheme should have a complaints procedure. (Complaints)


A right result?

It is important to stress that these and the other standards proposed in

this chapter are examples only; they are intended to demonstrate the
possibility and potential value of national standards, not to dictate
exactly what those standards should be. They are put forward in the
belief that all forms of advocacy are interdependent, and that the
advocacy culture described in the last chapter needs a degree of unity
at its core, as well as a respect for diversity, if it is to flourish.

How might such national standards be

It was stated in Chapter One that no regional or national advocacy
forum has hitherto acquired both the breadth of membership and
the credibility needed to develop and implement such standards. But
the National Citizen Advocacy Network (NCAN) envisaged in the
Valuing people White Paper could transform this situation, and give
real impetus to the development of authoritative standards, if it is
implemented wisely.
Valuing people gives only the briefest definition of what it means by
citizen advocacy, and even this is in a footnote:
Citizen advocates (that is, volunteers) create a relationship with a
person with learning disabilities, seeking to understand and to
represent the person with learning disabilities views. (DoH, 2001,
p 46, note)

This emphasis on voluntary relationship is welcome. Perhaps for the

first time, it signals government recognition of the validity of personal
advocacy as described in Chapter Four. It is seen that some people
with learning disabilities (and the same is presumably true of members
of other groups) may only be able to express themselves through a
partnership process that offers support, encouragement and the
opportunity to develop roles other than that of client.
How can this policy initiative best be turned into an effective
advocacy infrastructure? In the light of what has been written earlier
in this chapter, it can be argued that NCAN will need to be both
broadly-based and clearly focused on advocacy principles. It will need
to be broadly-based because too narrow a definition of what constitutes
citizen advocacy will simply perpetuate the sectarianism that has
hitherto undermined the advocacy movement. It is therefore to be


Looking at standards

hoped that all volunteer-based advocacy schemes will be invited to

join the network, even if they do not identify with the traditional
citizen advocacy model. Within this broad framework, however,
principles and standards for the differing forms of volunteer-based
advocacy will need to be clearly stated and maintained, in order to
prevent them simply merging into an ill-considered hybrid.
That such a broadly-based yet principled approach can work has
been demonstrated by the success of Advocacy 2000 in Scotland. There
is no reason why NCAN should not be able to enshrine, defend and
promote principles and standards for traditional citizen advocacy
alongside those for what was described in Chapter One as volunteer
advocacy. It is to be hoped, too, that good lines of communication
can be established between NCAN and professional casework
advocacy schemes; the debate about standards needs to be as broadly
informed as possible.
If the national standards proposed earlier in the chapter can provide
a core of unity for the advocacy movement, how might the
development of standards specific to each different form of advocacy
(such as NCAN may develop) impact on these different forms? To
this question, the remainder of this chapter will seek to contribute
some answers.

Citizen advocacy
Standards for adherence to citizen advocacy principles are, as we have
seen, already articulated in CAPE, and reinforced in Learning from
citizen advocacy programs (OBrien, 1987) and the CAIT evaluation
pack (Hanley and Davies, 1998). For many within the citizen advocacy
movement, CAPE determines not only the success of a scheme, but
also its validity. Only if a scheme is following, or aiming to follow, the
CAPE standards, is it seen to have a right to call itself a citizen advocacy
project. The standards aim to ensure that citizen advocacy is as unlike
service processes as possible; that it admits as few as possible of those
interests and procedures which allow people to be seen as anything
less than people. In this sense, CAPE was the first document to set
out the need for an autonomous advocacy culture.
However, as we saw in Chapter Three, CAPE has not, in fact, set
the standards for more than a fraction of UK advocacy schemes, despite
the citizen advocacy model having influenced and inspired many more.
This may in part be because some of the standards, such as those


A right result?

requiring non-statutory funding, are very hard to follow in the UK.

But it may also be because the very comprehensiveness of the standards
appears to create a very exclusive definition of true citizen advocacy.
Must a scheme be fully implementing all the standards from day one
in order to be a real citizen advocacy scheme? Or does a smaller
group of core standards represent the heart of the model, so that a
scheme which stood by at least these core standards could still say it
practised citizen advocacy? The citizen advocacy movement has not
been able to determine these questions, and this lack of agreement
has probably weakened the identity of the citizen advocacy model in
the UK.
The CAPE standards measure adherence to citizen advocacy
principles, but not the effectiveness with which these are implemented.
The wish of citizen advocacy schemes to do away with a conventional
quality standards approach here is understandable, given that this is
rooted in a service model which they reject. However, this outlook
becomes excessive if it leads schemes to banish the idea of
professionalism altogether, on the grounds that citizen advocacy is
informal. Much of citizen advocacy is indeed informal, and this is
true not just of the partnerships themselves, which often evolve as
friendships, but also of advocate recruitment and preparation.
Advocates are as likely to be recruited through conversations in cafes
and supermarkets as they are through advertisements. Their
orientation may or may not include a detailed introduction to the
citizen advocacy model. But citizen advocacy coordinators are not
unique in this way of working. Detached youth workers or health
workers may adopt highly informal strategies. But this is not to say
they are not professional (they may need to be more professional
than most), nor that such professionalism cannot be monitored or
enhanced by the appropriate mechanisms. The same is surely true of
paid citizen advocacy staff.
One-sided emphasis on the informality of citizen advocacy
obscures the considerable professional expertise that does, in fact, exist
among citizen advocacy coordinators. It could hardly be otherwise.
To gain access to people deemed to be vulnerable, to listen to them,
and to create the means by which advocacy can work for them requires
a range of skills. It should be possible to acknowledge and reflect on
these skills without undermining citizen advocacy principles.
Viewed in this light, adopting some minimum standards for
coordinators practice may convince funders and others of the
considerable professional skills that exist within citizen advocacy, even


Looking at standards

though these skills are not an end in themselves but are directed to
the creation of freely given advocacy partnerships. However informal
their approach, citizen advocacy schemes exist for a purpose. If this is
defined as matching people with disabilities and resourceful
community members who would otherwise be unlikely to share their
lives (OBrien, 1987, p 15), then schemes must acknowledge an interest
in, and responsibility for, the results of these introductions. If the
following elements are essential to the success of partnerships, then
some core standards may be possible to define them:

selection of citizen advocates

preparation of advocates
agreeing the match between advocate and partner
monitoring and supporting partnerships
good advocate conduct.

Again, as with the uniform national standards discussed earlier in this

chapter, there is a question as to which body would develop such
standards, were they agreed to be desirable. Citizen Advocacy
Information and Training (CAIT), the national focus of the citizen
advocacy movement, has adopted the traditional approach of
upholding citizen advocacy principles while avoiding any
formalisation of advocacy roles. The British Institute of Learning
Disabilities (BILD) on the other hand has recently produced both a
training pack for citizen advocates entitled Pathways to citizen advocacy
(Brooke and Harris, 2000) and draft Guidelines on good practice in ctizen
advocacy, both of which have a pragmatic focus on developing the
effectiveness of advocacy. Both initiatives could in principle form the
basis for quality standards, but both have drawn criticism. In particular,
the implication that citizen advocates need prior training in advocacy
in general is seen as undermining the primacy of their relationship
with their partner. More will be said about Pathways to citizen advocacy
in the next chapter.
Both the principles and the effectiveness of citizen advocacy need
safeguarding, and standards may have a part to play here if the
mechanism for developing them can be found.


A right result?

Volunteer advocacy
Volunteer advocacy is a definition that is still taking shape. It does
not refer to a precise model of advocacy, but denotes all those schemes
which, while they do not support the long-term one-to-one
partnerships that are at the heart of the citizen advocacy model,
nonetheless see voluntary commitment as an essential ingredient in
advocacy. Typically, volunteer advocates will support partners through
specific issues and withdraw once these are resolved; this process may
also be referred to as crisis advocacy. At its best, this approach can
allow schemes to deliver some of the expertise normally associated
with professional casework advocacy through a partnership which
retains something of the understanding and commitment of personal
Finding the right citizen advocate for someone can take many
months; volunteer advocacy schemes are likely to have a trained
advocate available at short notice. This means that volunteer advocacy
can make a more immediate impact on service processes. Advocates
can quickly be found to represent partners in tribunals, assessments
and complaints procedures. But this strength is not without its dangers.
The very responsiveness of volunteer advocacy can help to breed a
crisis culture in which anyone who is not in dire straits is deemed to
have no need of advocacy or other forms of support. Involvement in
such advocacy often yields striking results a court case won, a benefit
regained and there will always be a need for it. Preventive or
developmental approaches are less glamorous; yet it remains a fact
that most people, given a choice, would prefer to avoid crises, however
good the support available.
Allied to this is a danger of tokenism. Schemes are sometimes
approached by services to provide an advocate for Johns review
meeting for example. The approach may be well meant, but it carries
an assumption that (a) this will be the only chance John gets to
comment on his services this year and (b) that he could not possibly
wish things otherwise. Advocates are for people, not for meetings,
and schemes may wish to spell this out in their standards.
Areas in which volunteer advocacy schemes may wish to develop
their own specific standards might be as follows:
Who owns the advocacy? Does it rest entirely with the partner
and advocate, as in citizen advocacy, or is the advocate managed by
the scheme? Can advocates be removed from a particular piece


Looking at standards

of advocacy casework by the scheme manager? Under what

Who decides when a partnership should end the partner, advocate
or scheme?
How will the scheme work with people who are less able to make
their choices known?
If the scheme sees itself as managing the delivery of advocacy, then
standards for the training of advocates, for example, may also be
appropriate. Some volunteer advocacy schemes are already exploring
the possibility of external accreditation of advocates via universities
and colleges, and this could yield benefits in terms of the quality and
consistency of advocates performance. Safeguards may need to be
developed, though, to ensure that those who gain accreditation do
not seek to pass themselves off as freelance qualified advocates.
Because volunteer advocacy covers such a diversity of schemes, it
is hard to envisage uniform standards for them other than the sort of
minimum standards which we have suggested for all advocacy schemes.
However, the three areas set out above might provide a framework
for standards specific to individual schemes.

Professional advocacy
As we saw in Chapter Three,Atkinson (1999) sees professional advocacy
as offering a promising way forward for the advocacy movement as a
whole. Government sponsorship of the Patient Advocacy Liaison
Service (PALS) idea reinforces this perception; and if advocacy is made
a statutory entitlement under reforms of the 1983 Mental Health
Act, it is quite possible that the government will require more or less
professional standards here, too. Of all the different forms of advocacy,
professional advocacy appears to sit most comfortably with BestValue
notions of performance, targets and outcomes. The technical advocacy
approach of helping someone to get the result they want, no more,
no less, seems close to conventional ideas of a service.
But is this really true? The striking thing about many professional
advocates is how far they retain a voluntary ethos. We know of a
number of such advocates who have regularly worked way over their
paid hours because of their personal commitment to the individuals
they are supporting. In addition, most professional advocates will feel


A right result?

that their role is not simply about representing people; it is also about
empowering them:
Jean is a mother who has experienced mental ill-health. She has
recently been detained under the Mental Health Act, but now a
discharge meeting is planned.A professional advocate, Mustafa, has
acted for her throughout her detention. He asks her if she wants any
help with childcare when she returns home.
If I ask for help with the kids, theyll take them into care, says Jean.
Social services have a duty to give you proper support, says Mustafa.
And you have every right to ask for help. I could ask on your behalf
... but it might be more effective coming from you.
Jean is not sure if she can raise the issue, but after further
encouragement from Mustafa, she agrees to do so. When she makes
her request at the discharge meeting, the social worker is receptive:
What times of day are most difficult for you? she asks Jean. Support
is arranged for these times.

In this scenario, a technical advocacy problem has been solved; but

just as importantly, by believing in Jean and encouraging her to speak
for herself, Mustafa has helped her to begin to develop a relationship
with the services that is based on need and legitimate entitlement,
rather than on fear. Thus even where advocacy is supposedly at its
most technical, in the professional casework setting, clear elements of
personal advocacy remain. As suggested earlier in this chapter, what
establishes the viability of any advocacy role is the fact that the advocate
is uniquely on the side of the person they support. Professional
advocates may demonstrate this simply by following their clients
instructions to the letter; equally, however, they may demonstrate it
through empathy or encouragement, attributes which bear the
hallmarks of personal advocacy.
If this perception is correct, it confirms that however much personal
and technical advocacy may differ philosophically, in practice they
can never totally be separated. However tempting it may be to view
casework as essentially a different form of activity from partnership
advocacy, the temptation should be resisted. For if those who


Looking at standards

commission advocacy are allowed to believe that it can be neatly

divided into problem solving on the one hand, and befriending on
the other, and that they can purchase the former while dispensing
with the latter, all forms of advocacy will be falsified. There will be a
wholesale professionalisation of the concept and it will become the
property of advocacy services which are scarcely less remote and
impersonal than the health and care services to which they were
supposed to promote access. The need for coherence and unity in
the advocacy movement has never been stronger; the opportunity to
achieve them may not come again.
The national standards for advocacy principles suggested earlier in
this chapter might help professional advocacy schemes to avoid this
kind of absorption into the service culture. In particular, the standards
for the independent ownership of advocacy schemes, and for control
of the duration of partnerships may help to retain the essential personcentredness of advocacy. These could be supplemented by standards
specific to professional advocacy. Standards covering the following
areas could be useful here:
Standards in professional advocacy?
Administrative activities
The advocateclient relationship
Advocacy outcomes
Empowerment and self-esteem

Administrative activities. Is the scheme office based in an accessible

location? Are there efficient and clear systems for dealing with referrals,
queries and requests for information? Are waiting times kept to a
minimum? Do office staff deal with enquiries in a courteous and
respectful way? Are there adequate information and recording systems?
Are policies and procedures clear, accessible and relevant to the work?
The advocateclient relationship. Was the advocate accessible and available
at the times and places required by the client? Did they listen to and
communicate with the partner in a respectful and non-judgemental
manner? Did they do the things that they said they would, at the
times they said? Did they honour an appropriate level of
confidentiality, and respect gender and culture issues? Were the


A right result?

advocacy techniques appropriate to the situation? Did the client feel

involved and included at all times?
Advocacy outcomes. What was the outcome of the advocacy process?
Did the client achieve their initial goals? What changed as a result of
the advocacy intervention? Has the client been treated fairly and
equally, and been heard? Were their views acted on? Is the client
satisfied with the outcome of the advocacy process? Would they use
the scheme again?
Empowerment and self-esteem. Does the client feel empowered as a result
of their relationship with the advocate? Are they more aware of their
rights? Have they developed any sustainable self-advocacy skills? Do
they feel more able to tackle problems and issues themselves in future?
Have they been supported to develop their own opinions and

Peer advocacy
Peer advocacy is still an emerging form. It centres on the belief that
a shared experience of disadvantage or discrimination enables the
advocate to be on the side of the partner or client in a way that is
particularly meaningful. Individual peer advocates may act within
the models of advocacy already discussed in this chapter; that is, they
may be citizen, volunteer, or professional advocates. But there are
also a number of schemes devoted exclusively to developing peer
advocacy where, for example, users of mental health services are
supported by other users.
There is no single definition of how peer advocacy schemes should
work. Not only may the peer advocate offer a partnership- or
casework-based approach, the very distinction between helper and
helped may be abolished in an advocacy relationship that is founded
on the idea of mutual support. Hence it is not possible to suggest a
single set of standards for peer advocacy. But the question of standards
is still relevant. In discussing the evaluation of citizen advocacy in
Chapter Three, it was suggested that a principled advocacy relationship
is not necessarily an effective one. The same point applies to peer
advocacy; the peer relationship may be realised and highly effective
in some instances, but not so in others. There will certainly be a need
for monitoring here; and individual schemes may feel that standards


Looking at standards

also have a part to play in reinforcing good practice. The United

Kingdom Advocacy Network (UKAN) Code of Practice is particularly
relevant, since it provides safeguards for advocacy that is wholly owned
by service users.

Health advocacy
Although not a specific advocacy form, the issue of health advocacy
for minority ethnic communities has gained prominence in recent
years, driven primarily by a significant research project undertaken
by Silvera and Kapasi on behalf of the Kings Fund (Silvera and Kapasi,
2000).The research involved a mapping exercise of both specific and
generic advocacy agencies that had a role in advocating for minority
ethnic communities in a general health context. The authors
highlighted a number of areas for action, including the development
of effective networks; capacity building among advocacy providers;
the development and funding of policy and research in the field;
improving funding and commissioning of advocacy; developing
partnerships; training and awareness-raising; and the development of
common standards. The last point is the most significant in the context
of this chapter Silvera and Kapasi go as far as to suggest a number of
possible standards which they felt would help to raise the quality and
effectiveness of health advocacy schemes:
... there was a clear case to develop standards that improved the
organisation and delivery of services and the performance and
behaviour of advocates themselves. These would provide clearer
and more objective ways for assessing effectiveness. (Silvera and
Kapasi, 2000, p 85)

The authors propose two sets of measures for health advocacy schemes,
the first being essential criteria such as customer satisfaction, basic
data collection and clearly stated service aims and the second being
added value measures such as improved social inclusion, impact on
wider service delivery and on individual health. At the time of going
to press the Kings Fund is now progressing to stage two of this process,
by funding an initiative aimed at implementing many of the
recommendations of this research.


A right result?

Our discussion of advocacy standards has necessarily been both

tentative and selective. Tentative, because the whole subject of standards
is so contentious, and selective because a comprehensive survey of
possible advocacy standards would fill a book in its own right.
Nonetheless, some conclusions have emerged. First, it seems at least
possible that some national minimum standards could be set for all
kinds of advocacy which would not undermine scheme diversity, but
which would protect some core advocacy principles, especially
independence. Second, it has been suggested that different forms of
advocacy, or individual schemes, could adopt further standards to
support their work in general, and to combat weaknesses or imbalances
in particular. In citizen advocacy, standards might help to counter an
excessive emphasis on informality. In volunteer and professional
advocacy, they may help to ensure that personal advocacy perspectives
are at least to some extent defended, and absorption into the service
culture avoided.
In relation to both volunteer and professional advocacy, the training
of advocates has several times been mentioned as a quality issue. It is
with differing approaches to the training of advocates that the next
chapter is concerned.



Learning, skills and validation

So far we have focused primarily on organisational issues and processes

in the development of effective advocacy. Given that the bulk of
advocacy is sanctioned and supported by advocacy agencies, this is
appropriate, but what about the individual advocates? At its most
fundamental level, advocacy exists as a relationship between two people,
the advocate and their partner. Although the advocate will have been
given access to induction, training and support from the advocacy
agency, they remain relatively autonomous. It is the individual
advocate, not the scheme, who will be responsible for setting both
the tone of and agenda for the advocacy partnership. While a key
value of advocacy is that the advocate and partner work collaboratively
to agree the terms of the relationship, it needs to be recognised that
there exists a power imbalance between the two parties in the
relationship, at least in the first instance. That is, the partner or client
is in need of support or assistance, which the advocate chooses and is
able to provide.
Although overly simplistic (some partners are entirely clear what
they want from advocacy), this in essence is how many advocacy
relationships begin. Hence the advocate carries a great duty to use
their not inconsiderable power responsibly and with good intent. The
role of the advocacy scheme in this context is to put in place systems
to ensure that first, the advocate is aware of this responsibility and
second, is equipped with the skills and insight to act in an empowering
way. Different types of scheme will tend to do this in different ways.

Citizen advocacy and training

There are differences of perspective and approach between citizen
advocacy and other forms of advocacy whether they be volunteer or
paid worker-based, in relation to training. In citizen advocacy, much
greater emphasis is placed on the mutuality of the advocacy


A right result?

relationship, ascribing a great deal of autonomy and independence to

the advocate and partner to set their own agenda and follow their
own path. This is not a business transaction between a professional
and a client, rather it is an equal partnership based on the key values
of community and inclusion. The citizen advocate is an ordinary
person who brings a rich and varied life experience to the partnership
and makes a commitment to utilising that experience to ensure their
partner is also heard and respected as a citizen. In this sense, it is not
necessary or desirable for the citizen advocate to undergo a rigorous,
standardised training programme before they can be considered ready.
Citizen advocacy schemes place a great emphasis on the process of
matching advocates and partners based on common values,
experiences and interests. This ensures that the advocates unique
skills and talents are put to best use, rather than requiring them to
conform to a predefined set of criteria or template for what an
advocate should look like.
This is not to say that citizen advocacy schemes do not offer training
and support to advocates: most schemes provide induction or
orientation, in part to explain the key values and principles of citizen
advocacy to potential advocates but also to provide an opportunity
for scheme coordinators to get to know the participants. In this way
citizen advocacy schemes are able to select out individuals who may
not be suited to becoming citizen advocates, but who may be
redirected towards some other form of voluntary work. During the
course of the advocacy relationship, advocates may also be offered the
chance to attend regular support groups or briefing sessions, and meet
with scheme staff and other advocates to discuss issues of interest or
A core belief in citizen advocacy is that marginalised people not
only have a right to representation, but that this representation is
most enduring and effective if it grows out of the organic and dramatic
relationships which link ordinary members of the community. This
is why the theme of inclusion is so fundamental in citizen advocacy:
it is the foundation on which the more tangible advocacy outcomes
are built. Training, by definition, seeks to add something to the
volunteer, be it skills or knowledge; added together, these inputs define
the volunteers role. Citizen advocacy schemes, on the other hand,
feel that such additions actually diminish the advocates capacity to
offer the partner the equal human relationship that anchors all true
advocacy. Instead of committing themselves, the trained advocate is


Learning, skills and validation

enacting a role; and the partner is yet again cheated of real human
concern, and given an intervention instead.
The ideals of citizen advocacy are compelling; so compelling,
perhaps, that practitioners sometimes overlook the fact that they are
ideals, and can only be achieved (or worked towards) through real,
and sometimes slow, processes. So one must contrast with the citizen
advocacy ideal of a freestanding, effective partnership between two
citizens, rooted in ordinary human concern, the fact that many new
advocates will be uncertain of their role; that they may never have
negotiated with service providers before; that their partners life may
look anything but ordinary at first sight. Should citizen advocacy
schemes ignore these facts, and simply assume that every partnership
is ideal from the moment it begins, so long as it follows citizen advocacy
principles? Such a position is surely untenable. Just as it was argued
in the last chapter that citizen advocacy coordinators have a level of
responsibility for the quality of the partnerships they create, so it can
be argued here that they have a responsibility to promote the
development of advocates and advocacy partnerships towards the ideal
(however that is conceived). The orientation or induction of citizen
advocates, and their ongoing support, may indeed need to be tailored
to local, and even individual circumstances; but this is not to say that
anything goes.

Pathways to citizen advocacy

The Pathways to citizen advocacy training pack (Brooke and Harris,
2000) represents a first structured attempt at the task of developing
the effectiveness of citizen advocates. It is a modular training package
designed specifically for citizen advocacy schemes working with people
with learning disabilities. The pack is divided into two parts. The
seven Foundation units in part one aim to provide:
initial preparation and training for citizen advocates who will
partner people with severe learning disabilities. (Brooke and Harris,
2000, p 2)

while the nine Advocacy in Context units in part two offer:

continued training and development of citizen advocates in
ongoing advocacy partnerships. (Brooke and Harris, 2000, p 2)


A right result?

The units comprise:

Foundation units

What advocacy is about

Disability awareness and attitudes
Communication: getting started
Communication: relationship building
Choices and decision making
Conflicts and complaints
Approaches to problems

Advocacy in context units

Difference and diversity

Families, friends and volunteers
Working with professionals
Health and learning disabilities
Choice in where to live
Choice in daytime opportunities
Education and learning disabilities
The law, learning disabilities, and citizen advocacy

Each unit is designed to last between one and three hours and includes
teaching, group discussion and practical exercises such as case studies.
The packs authors recommend that, wherever possible, people with
learning disabilities themselves should be engaged as trainers.
As presented, Pathways has a somewhat prescriptive feel. Each unit
begins with a statement of learning outcomes:
After completing this unit participants will be able to... (Unit F5,
p 2)

Even if unintentionally, this may create the impression that citizen

advocates must reach a certain level of knowledge before they are
qualified, or that completion of the units bestows some kind of
accreditation on the advocate. Either perception would undermine,
not so much the principles, as the entire rationale of citizen advocacy.
For here it is the match between partner and advocate, rather than
any expertise the advocate holds, which is the root of the partnership.


Learning, skills and validation

Of course, it is important that advocates bring insight and knowledge

to their partnerships, and used flexibly the modules can help advocates
to reflect on, and learn about, issues relevant to their specific partners.
However, there needs to be a stronger emphasis on the prior learning
the ordinary life experiences which citizen advocates bring to
their role.
Again, though the emphasis on training by people with learning
disabilities is welcome, the pack overall feels too much trainer-based.
The primary impression is very much of advocates as students and
workers rather than as partners and contributors. Even in the
Advocacy in Context units, which are designed for advocates already
supporting a partner, the learning outcomes make no mention of the
value of learning from partnership experiences. Again, this seems to
negate the distinctiveness of citizen advocacy, which aims at
empowering people through participation in community and not
primarily through receipt of services. A module about encouraging
advocates (and partners) to share their experiences informally and
constructively might redress the balance somewhat.
Ultimately, it will be the take-up of the Pathways to citizen advocacy
pack which determines whether or not it is successful. It is possible
that, in its present form, it does not have enough of a citizen advocacy
feel. The pack may develop, or it may spur others to develop
alternative resources for encouraging, developing and empowering
citizen advocates and advocacy partnerships. At the very least, by
requiring the citizen advocacy movement to focus on tasks as well as
on ideals, it has opened up a large and legitimate area of debate.

Different approach, different skills?

Given that citizen advocacy is founded on the fundamental assumption
that advocacy relationships are one-to-one and long-term, it is possible
to be relatively confident that if the matching process is carried out
well, the foundation will be laid for an effective partnership. However,
in a more generic casework advocacy scheme where advocates (be
they volunteers or paid staff) support a number of partners, the issue
is more complex. At any one time the advocacy worker may be
supporting several individuals with a wide range of issues and from a
variety of backgrounds. Although many such schemes have a single
client-group focus (for example mental health, older people), a plethora
of different experiences and problems may still arise. In this event,


A right result?

the casework advocate needs to be both versatile and knowledgeable

across a much wider spectrum. This may include housing, welfare
rights, health and community care legislation and local service
provision. In addition to this comprehensive knowledge of the system,
the casework advocate also needs the full range of advocacy skills and
techniques to be able to support and represent their partner effectively.
This combination of skills and knowledge is seen as an essential
ingredient for a successful casework advocacy approach, as shown


Active listening

Relevant legislation/rights

Empathy and openness

Local service systems

Action planning

Complaints procedures

Collaborative working

Other sources of information

and advice

Negotiation skills

Key personnel

Persistence and tenacity

Range of issues and

possible solutions

Communication and

Particular needs and wishes of


Evaluation and monitoring

Advocacy principles and


There are implications here for both the recruitment and training of
advocates, volunteers or paid workers, within casework advocacy. Not
only will the scheme want to consider specifying the essential skills
and knowledge required at the recruitment stage, but also in relation
to ongoing training and supervision. In other words, if advocates do
not already possess all the requisite abilities, how can they acquire
Unlike traditional health and social care disciplines such as nursing
or social work, advocacy does not require a specific qualification. Given
that its roots are in everyday community life and social action, it is
not surprising that advocacy has flourished without the need to impose
rigid training programmes or minimum skills requirements. However,


Learning, skills and validation

as the advocacy sector has grown to incorporate a much larger

proportion of casework schemes using paid advocates, so the demand
for more formal training programmes has increased. The impetus for
training has come in part from the advocates themselves, keen as they
are to provide the best possible support to users. There is also a link
to quality and effectiveness, in particular the requirements of funding
bodies who will often insist that advocates have access to minimum
levels of training and supervision. For advocacy agencies such
requirements may provide a useful tool for negotiating a reasonable
level of funding for training within project budgets. There is precious
little free training available to advocates, and conferences and highlevel policy seminars are notoriously expensive.
Training for advocates, whether induction or ongoing, is essential
for the continuous development of an individuals skills and knowledge.
It also provides an opportunity to revisit core advocacy values and
principles as well as offering a useful networking facility. The induction
aspect of training is particularly important. It sets the context within
which an advocate will operate and should, if properly coordinated,
provide a grounding in both general advocacy philosophy and specific
organisational practices. A typical induction programme may cover
some or all of the issues outlined below:
Induction training checklist
Orientation to scheme/agency, other team members, policies and
procedures, referral systems, local profile
Introduction to advocacy values and key principles
Advocacy skills listening, negotiating, empowering
Equal opportunities and anti-discriminatory practice
Introduction to local service systems and key personnel
Shadowing other advocates
Administration record-keeping, client file systems, time-keeping

There may be any number of appropriate teaching and learning

methods adopted by advocacy schemes to ensure advocates have the
requisite skills and attitudes. To an extent, particular agencies must
have the freedom to choose from and adapt a wide range of approaches,


A right result?

but the advocate also has the right to expect certain basic facilities to
be in place for their arrival at the scheme. Training should be an
ongoing process which is not limited to an initial induction programme
but which enables the advocate to learn and develop continuously.
There is scope for a great deal of flexibility both in terms of the
content and method of training, encompassing approaches as diverse
as on-the-job training, reading key texts and role play. The following
is a summary of the main training methods used in a casework or
volunteer advocacy context.

On-the-job learning
To a great extent advocacy skills and approaches are best learned in a
real-life environment that enables both the advocate and their partner
or client to contribute to and benefit from the experience. By working
together to challenge a decision or resolve a dispute, both parties are
in an ideal position to try out different techniques and review their
effectiveness. In this way, advocates and partners gain an insight into
the range of advocacy approaches (the process) and results (the
outcome). The subtleties and nuances of each approach can be
scrutinised and evaluated in the light of actual experiences, enabling
the advocate to reflect on their practice and modify as appropriate,
for example, the decision about whether to write a letter or make a
telephone call to a particular professional; when and how to request a
case review or reassessment; or how to articulate a particular problem
the client or partner is experiencing.
This process of reflective learning can be greatly assisted by having
access to a supportive manager and staff team. In such an environment,
advocates are supported when making mistakes and in learning from
them. In this respect, there are clear advantages to advocates being
based in dedicated teams rather than dispersed in organisations for
which advocacy is only one element of a range of other services. The
dedicated, independent advocacy agency is well equipped to support
individual advocates and develop shared learning across the team.
Although it is essential that agencies have in place clear policies around
confidentiality and access to information, most teams should have
established systems for sharing information about particular clients in
order to pool ideas and approaches.
However, there is a danger that in such situations clients can become
guinea pigs for the advocates learning, especially in the case of new


Learning, skills and validation

and inexperienced advocacy workers. Given that casework advocacy

is a relatively new phenomenon this is to an extent inevitable. There
is no template for effective advocacy and what works well in one
situation with one person, may not work at all in another. Consider
the following example:
Abdihakim approaches the advocacy scheme after his attempts to get
rehoused have failed. Although he believes he has a good case for a
transfer to another area (he has experienced both racial harassment
and verbal abuse from neighbours in relation to his mental health
problems), his local housing office has failed to act and he is becoming
increasingly frustrated.
Abdihakims newly appointed advocate decides the best approach is
to write to the local MP about the situation, and claims that the housing
department, in not responding to claims of racial harassment, is itself
operating in a racist manner. He also copies this letter to the local

Although the approach adopted by the advocate in this example is

not necessarily wrong, there might well be a variety of other less
drastic measures that would be worth trying before going to the press.
In this scenario, these may include meeting with the housing officer;
arranging a case conference; seeking written support for the clients
case for rehousing from social workers, GPs and others; or writing to
the housing office manager.
It is not clear from this example whether the advocate was operating
on the explicit instruction of the client or whether he had chosen
the particular course of action under his own initiative. It would be
incumbent on anyone acting in this way to ensure their client was
fully informed of their rights and choices, and possible likely outcomes
of any such activities. The client should always have the final say over
what action is taken on their behalf, and should be encouraged
wherever possible to advocate for themselves, with support.
At the heart of any concept of in-role learning should be an
emphasis on learning from the advocacy partner. As stated previously,
partners are the only experts in advocacy. Just as their expertise may
emerge in a variety of ways, so schemes need to impart to advocates


A right result?

a range of techniques for learning from their partners. In some

situations this will mean demonstrating to the partner that it is their
views alone that inform the advocate; that the advocate will convey
these views, and vigorously represent them, to whichever agency is
appropriate. In other situations, the advocate may need to be much
more proactive, encouraging a partner who has low expectations of
life to see that better options are available to them. In suggesting
these options, the advocate will need to be informed by all of their
encounters with the partner, trying to see through the partners eyes
possible ways ahead. Advocates have found out their partners interests
and wishes in all manner of ways; it is important that this diversity is

Role play
Another effective learning method that may have relevance to
advocacy schemes is the use of role play. This involves a number of
actors (the training participants) adopting different roles within a
given scenario and playing out those roles to their natural conclusion.
Typical examples of role-play scenarios include going to a hospital
appointment, and complaining about poor service in a restaurant.
Each actor is briefed about their role and given cues as to how a
particular character might act and react. Other participants who do
not take part in the role play are asked to comment on how each
person behaves in their role and what can be learned from this. At
the end of the role play actors are supported to debrief and come out
of role. It is also possible to replay a particular scenario with participants
swapping roles in order to gain insight into what each party thinks
and feels.
Role play enables advocates to experience at first hand a range of
different advocacy situations and practice their skills in a safe and
supportive environment. Although clearly not the same as a real-life
situation, it is possible to get a sense of what it feels like to be cast in
a particular role, whether that be as a service user, advocate or service
provider.Role play can be a good way of conveying the energy and
dynamics of advocacy although it does have its disadvantages. On the
positive side, the fact that it is essentially a staged drama means that
nobody will suffer if things go wrong there are no real-world
repercussions from a poorly judged advocacy intervention other than
slight embarrassment and the opportunity to try again. For instance,


Learning, skills and validation

the role-play actors may experiment with hard and soft approaches
to particular situations such as tribunals or case conferences.
Such training might have given Abdihakims advocate in the above
story a broader sense of the options available. The advocate is able to
reflect instantly on both the advocacy process and outcomes, revisit
the role scenario immediately to experiment with different methods
and their impact on peoples behaviour, attitudes and decisions. If the
role play is done in a supportive group environment, participants are
also able to take feedback from other group members and observe
their different approaches to the same role scenario. In this way
advocates have the opportunity to compare and contrast different
advocacy and representation styles.
There are some disadvantages to the role-play method of training
however. It is still essentially an artificially created situation, and in
real life people rarely get second chances. It also does nothing to
address the key advocacy issue of relationships, in that the actors are
often meeting for the first time in the role-play environment. Although
a useful tool for practising representation and negotiation skills, role
play does not allow for a critical analysis of the values of advocacy it
is a practice tool only. There is also the danger that, given the realistic
nature of most role-play scenarios, emotions can run high and
participants identify personally with their roles. For this reason, role
play as a training tool requires a skilled facilitator who can support
people getting into role and coming out of role. It is also essential
that participants are debriefed after each session so that issues from
the role play are not carried over into real life.

Classroom learning
The different advocacy forms revolve around a set of principles. These
principles include such key issues as independence, autonomy, loyalty
and equality, choice and the right to self-determination. It is crucial
that advocacy schemes actively promote and protect these values in
order that genuine, independent advocacy flourishes and survives in
a constantly changing environment.
This presents a challenge to advocacy schemes how to instil in
new and inexperienced advocates a sense of ownership of and
adherence to these particular values. It is possible to make available
to advocates the small but authoritative body of literature on the
subject (see below), but this does not address the issue of shared learning


A right result?

and a collective consciousness around advocacy philosophy, history

and practice. To achieve this, the advocacy scheme may need to resort
to more traditional learning and teaching methods such as workshops,
seminars and lectures, focusing on different advocacy models, principles
and definitions. Other related issues which can be tackled in this way
include learning about relevant legislation (such as the 1990 NHS
and Community Care Act, 1989 Childrens Act, and 1983 Mental
Health Act), learning about local organisations and service systems,
and other related disciplines such as counselling, advice, the law and
Beyond the initial induction training packages for new advocates,
which are traditionally organised in-house by particular advocacy
agencies, there is currently a lack of good-quality advocacy training
in this country. This is true both in terms of training specifically for
advocates (whether citizen advocates or casework advocates) and
advocacy awareness training for service providers and allied
professionals. The small amount of training that is available tends to
be in the form of one-day courses on particular advocacy issues such
as volunteer recruitment, equal opportunities and advocating for
people with particular needs or issues such as dementia. The concept
of a modular, comprehensive training programme that covers all aspects
of advocacy values and practice is still a relatively new one, although
there are currently some pilot projects in the UK experimenting
with different training packages. We have already discussed the
Pathways to citizen advocacy pack as an example of this genre.
In East London, two different accredited training pilots are currently
under way. The first is an entry-level core competency training course
entitled Advocacy for Accessing Services. This course is aimed at
people who have a basic understanding of advocacy issues and who
want to broaden their experience. The course lasts for six weeks and
on completion, students are automatically eligible for paid sessional
advocacy work in the East London area. The second course, the
Certificate in Advocacy, is a more advanced qualification accredited
by the University of East London and covers six areas: diversity and
discrimination; models and skills of advocacy; mind, body and culture;
understanding socially excluded adults in society; society and health;
and casework in advocacy. It is not clear whether such qualifications
will have any validity in the wider advocacy field, but they provide a
useful example of the direction in which the issue of accredited training
is headed.


Learning, skills and validation

Case studies
One particularly effective learning method in classroom-based
workshops is the use of case studies. These are realistic examples of
possible advocacy scenarios that enable participants, often in small
groups, to put into practice the theoretical understanding they have
developed during the training. In this way, advocacy values are clearly
linked to practice and trainees are encouraged to reflect on why and
how a particular approach works. It is possible to see why, for example,
advocates should avoid adopting a best interests approach to
representing people and instead concentrate on what their partner is
actually saying they want and need. Another example would be to
help trainees develop a clearer understanding of the relationship
between advocacy process and outcomes, that is, the style of advocacy
adopted may have a direct impact on the end result.

Reading the literature

There does exist a modest body of literature on advocacy, principally
on citizen advocacy but more recently on other models such as peer
or casework advocacy. Those written materials which do exist range
from relatively basic introductory articles on the benefits of advocacy
in a health and social care context through to detailed practical guides
for anyone setting up an advocacy scheme.
A great deal of the early written work was imported from the US,
primarily such influential texts as CAPE: Standards for citizen advocacy
program evaluation (OBrien and Wolfensberger, 1979) and Learning
from citizen advocacy programs (OBrien, 1987). In the UK, the first
attempts to produce an interpretation of the citizen advocacy model
include Citizen advocacy: A powerful partnership (Butler et al, 1988, revised
by Wertheimer, 1998) and Citizen advocacy: The inside view (Simons,
1993). More recently, publications such as Power tools (Leader and
Crosby, 1998) have provided a useful guide to local groups attempting
to set up an advocacy scheme from the grassroots, and the books
Advocacy: A review (Atkinson, 1999) and Advocacy skills for health and
social care professionals (Bateman, 2000) have contributed to the national
debate on what constitutes real advocacy. There are also a number
of texts focusing on evaluation of advocacy schemes, such as Advocacy
Network Newcastle (1995) and the Citizen Advocacy Information
and Training (CAIT) evaluation pack (Hanley and Davies, 1998).


A right result?

It must be noted that publications such as those listed are often not
easily accessible to individual advocates either in terms of availability
or content. This is especially the case with early works on citizen
advocacy as they are closely associated both by subject matter and
language to the social theories of normalisation and social role
valorisation. For a more detailed summary of the range of written
materials currently available on the subject, refer to the References
and further reading at the end of this book.

Training and accreditation

Any discussion of advocacy training should consider the question of
accreditation. On the one hand, as we have seen, the governments
plans for PALS and the reform of the 1983 Mental Health Act raise
the spectre of a professionalised and bureaucratised version of advocacy
which only those duly accredited will be able to practice. On the
other, there are more positive views of accreditation emerging from
within the advocacy movement. The question of standards, discussed
in the last chapter, has obvious implications here; if there were national
standards for advocacy, then only schemes which were accredited as
meeting them would be likely to receive funding and support. More
generally, the wish to develop the quality of advocacy has already led
a number of schemes and educational bodies to develop locally
accredited training courses.
Significant here are the courses being offered by St Andrews
University in both advocacy and self-advocacy, which lead to academic
qualifications. A number of advocacy schemes, too, are fostering links
with local colleges with a view to developing accredited advocate
training courses. Such initiatives are welcome in that they allow for
the creation of in-depth courses which few organisations could match
in-house. They may also provide an arena in which philosophies and
experiences of advocacy could be discussed and developed, away from
the pressures of day-to-day advocacy activity. But these courses raise
questions, too. How is it decided what level of learning or expertise
in an advocate warrants accreditation? What would accreditation
mean? That the advocate can now practise within a designated
scheme? That they can start their own scheme, or perhaps even begin
to trade as freelance advocates, charging fees to those they help?
Accreditation needs more careful discussion.
There is a need for schemes to develop practical, as well as principled,


Learning, skills and validation

identities. What advocacy is about can never simply be a set of beliefs;

the model proposed in Chapter Five stressed the need for the strongest
possible connections between the theoretical and practical aspects of
a scheme. Training clearly has a major role to play in turning principles
into practice, and in refining principles in the light of that practice. It
is therefore pertinent to ask:
Would accredited training promote better advocacy?
Should accredited training follow national norms?
There are four main benefits which might arise from accredited
1. Enforcing national standards for advocacy. If national standards of any
description were to be adopted, there would need to be mechanisms
for informing schemes and advocates about these. Accredited
training could have a role to play in ensuring conformity with
these standards.
2. Breadth and consistency. Accredited training could lead to volunteer
and casework advocates having a broader understanding of advocacy
in its different forms. Insight could be gained into key advocacy
principles and outcomes which may not all be apparent within the
work of their own schemes.
3. Social and political awareness. Accredited training would foster
understanding of the wider political context within which advocacy
exists, and its links to other social justice movements.
4. Status. Accredited training could enhance the status of advocacy
and of advocates. Nationally endorsed courses might provide good
opportunities for networking and the sharing of good practice.
Each of these arguments carries some weight. However, the benefits
envisaged in 2 and 3 do not necessarily depend on the existence of
accredited training, and would certainly not require national
uniformity. As regards 1, the national standards suggested in Chapter
Six were more related to advocacy principles than to advocate
performance, so training is not a key issue here. Finally, 4 may well set
alarm bells ringing! If the advocacy movement allows concern with
the status of advocates to usurp its concern for the status of partners,
a very questionable kind of professionalism creeps in; surely the last
thing that advocacy partners need is the creation of a Royal College
of Advocates.


A right result?

The main difficulty with an uncritical move towards accreditation

is that it is likely to lead to confusion between preparation for, and
legitimisation of the advocates role. It is entirely proper that volunteer
and casework advocacy schemes should wish to maximise their
advocates effectiveness by developing their learning and skills; but
such training does not make an advocate. In a sense, advocacy only
really exists in the situation where one person stands by another, either
with the latters consent, or else in single-minded commitment to
their interests. The relationship between personal and technical
advocacy is significant here; however much advocacy is described in
terms of skill, awareness, and technique (and each of these is important)
there is an irreducible personal element in all genuine advocacy which
cannot be codified or explained away. It is this personal element
this consent, this commitment, this trust which gives advocacy its
If training only prepares advocates for their role, but does not
legitimise that role (in the way that, say, a teaching certificate permits
someone to teach) the case for standardised national training for
advocates is further weakened. Preparation of advocates will need to
have regard to local circumstances as well as the wider picture. In any
case, the gulf that exists between the citizen advocacy standpoint on
training, and that of volunteer or casework schemes, makes any unified
system for accrediting advocates impossible. With citizen advocacy, as
we have seen, accrediting individual advocates would subvert the form,
although accreditation of schemes remains a possibility.
Does this mean that the accreditation of casework and volunteer
advocates is a dead end? Not at all. As was suggested earlier in this
chapter, creating links between advocacy schemes and academic
environments could be a source of insight and renewal. The
development of high-quality training should be welcomed, and it
seems only right that the completion of such training should be
recognised in some way. But training is not a panacea; it may contribute
to quality in advocacy, but it does not guarantee it. There is no single
set of skills, no single set of answers, which will spare advocates and
advocacy schemes the need to be constantly alert to the shifting crosscurrents of personal and technical advocacy.
The difference between the citizen advocacy and volunteer or
casework advocacy approaches to training has been a recurring theme
of this chapter. At first sight, the difference could scarcely have been
more marked: on the citizen advocacy side, a refusal to train advocates
on principle, on the other side an enthusiasm for any inputs which


Learning, skills and validation

might lead to more effective advocacy. As the chapter has progressed,

the difference has endured, but it has become narrower. On the one
hand, it was argued that citizen advocacy schemes do have a
responsibility to develop skills and resources which will help advocates
and partnerships to develop, indeed that such development is essential
if citizen advocacy ideals are to be realised. Pathways to citizen advocacy
marked a first, not entirely satisfactory attempt to support such
development. On the other hand, it was argued that some of the
more ambitious hopes for training and accreditation for volunteer
and casework advocacy need to be tempered in the light of the
distinction to be drawn between preparing and authorising advocates.
This distinction was related to a key theme of previous chapters: that
there is at the heart of all forms of advocacy a gap that is only filled by
the trust, or consent, that is established, when one person stands by




Writing a book about advocacy was never going to be easy. Writing

a book about advocacy that attempts to move forward the debate
within the advocacy movement has been harder still. Advocacy as a
concept is at best open to interpretation and variation, at worst prone
to corruption, dilution and ultimately, rejection. Despite the many
and varied attempts of both UK and US proponents of advocacy,
there remains an ambiguity about what advocacy actually is, what it
achieves and how it should be done. Some forms of advocacy (such
as citizen advocacy) are relatively well developed, with a clearly stated
philosophy, guidelines for practice and mechanisms for review and
evaluation. Others, like peer advocacy, exist only as pragmatic, informal
approaches that define who the advocates are rather than what they
do or how they do it.
The same discrepancies occur in the structure and organisation of
advocacy. There is no standard model of an advocacy agency that is
accepted across the board rather, there are as many variations as
there are local schemes. Some advocacy agencies are set up as
completely autonomous and independent bodies, with multiple
sources of funding, local management and high levels of user
involvement. Others exist as departments within large service provider
organisations funded under contract by the local or health authority.
Others still occupy the middle ground between these two extremes.
Although many within the advocacy movement would aspire towards
the former model and are actively working towards it, the reality is
that much of what currently happens in the name of advocacy is far
from the ideal of complete independence and freedom from conflict
of interest.
That is not to say that the efforts of individual advocates are
constrained to the point of being ineffective. As we have demonstrated
in previous chapters, there is more to independence than structural
separation from provider agencies. Advocates (and their partners)
must feel empowered to act autonomously whatever the circumstances,


A right result?

if necessary in spite of the structures and procedures that surround

them. This takes us back to the fundamental basis of advocacy the
relationship between two people, the advocate and partner, and an
unshakeable emphasis on dignity, respect and justice. The methods
may vary but the aim should be constant.
This work has sought to describe in detail the current dilemmas
and challenges facing the advocacy movement in the UK. These
dilemmas are primarily ones of methodology and of organisation,
although they also incorporate the specific and contemporary
preoccupation with standards and regulation. But what are standards
if not a tool for measurement, and what is regulation if not a process
of enforcement of these measures? Advocacy is a publicly funded
activity and as such warrants monitoring and evaluation. Is the money
being spent in the most effective way possible? Do users get what
they want from advocacy? In fact, do users even know what they
want or what their options are? It is a challenge for those of us
developing advocacy to ensure that we have the means to answer
these and other questions both in terms of how advocacy is organised
and also how it is implemented.
There follows a summary of the key issues raised in each of the
preceding chapters in an easily accessible format. The summaries
comprise a description of the current situation; an analysis of the
main issues and problems; a number of recommendations for future
consideration; and a series of questions which remain unanswered
(and hence could form the basis for subsequent work). How this
work is taken forward is for those individuals and groups within the
advocacy movement to decide. But take it forward we must, for
advocacy is too important to be left in the hands of those that do not
care about it, are not passionate about it.

The significance of advocacy

The current situation
There is a wide range of advocacy schemes in the UK. Not only do
these schemes support different groups of people, they work in very
different ways. In some, all advocacy is undertaken by volunteers; in
others, the advocates are professional caseworkers. Some advocacy
partnerships support the partner for as long as they wish; in other



instances, advocacy is provided just to help people sort out particular


Problems and difficulties

There is no single, simple answer to the question What is advocacy
for? This creates a danger of misunderstanding between different
forms of advocacy. The many different messages as to what advocacy
is really about are likely to confuse the public, policy makers and
potential funders, and this may lead to advocacy being marginalised
or distorted. Chapter Four suggested that there are two contrasting,
and sometimes conflicting, approaches at work in advocacy: the
personal and the technical. Personal advocacy is rooted in one persons
natural capacity for identification with another; technical advocacy is
based on an agreement that the advocate will pursue the partners
wishes. Though different schemes will tend to emphasise one or
other approach, they are nonetheless interdependent.

There is a range of advocacy outcomes which includes:

Social development

Different forms of advocacy may offer the right way for some
groups to achieve these outcomes, but may be less relevant to
Having different types of advocacy available within a given area
is likely to be a sign of strength, not weakness.
There is a danger that funders may only see the need for technical
advocacy. The advocacy movement needs to address this danger.
Schemes need to identify a range of means by which they can
record advocacy outcomes.


A right result?

Topics for discussion

Does your scheme lay greater emphasis on personal or technical
Which of the outcomes are achieved within your scheme?
How are these outcomes identified and recorded?
How does the work of your scheme relate to what other local
schemes are doing?

An advocacy culture: towards a distinctive identity

The current situation
There are a number of different forms of advocacy, and many different
types of organisation providing advocacy. Some are independent
schemes that provide only advocacy, others may be part of local
umbrella organisations such as Councils forVoluntary Service (CVS),
or of regional or national agencies, some of which also provide care
services. Advocacy is substantially funded by local authorities and the
NHS; it could not be wholly funded by the trust sector.
The local nature of most advocacy schemes makes it difficult to
organise national or regional initiatives to develop advocacy.

Problems and difficulties

Funding from statutory agencies presents two major problems: conflict
of interests and loss of independence.
It is difficult for advocacy schemes to challenge the organisations
that fund them. They may therefore not be effective in representing
partners in these situations. With such funding is likely to come a
requirement that advocacy is managed, delivered and monitored in
line with other forms of service provision. This may undermine the
independence of advocacy, and the loyalty of advocates to partners.
The advocacy movement struggles with these threats because it
has no clear identity of its own. There is a need to define, not only
principles, but all the processes which contribute to good advocacy.



The outline model in Chapter Five could be used as a
theoretical framework for defining advocacy and for developing
advocacy schemes.
A preference should be established for the provision of advocacy
through advocacy only organisations.
A consensual approach to advocacy funding should be adopted
where possible, and competitive tendering be used only as a
last resort.
Advocacy schemes should consider whether, in referring to
themselves as services, they are sending misleading signals to
their partners and their funders.

Topics for discussion

Is advocacy distinct from service provision?
Is the model suggested in Chapter Five relevant to your scheme?
Does it apply to other schemes?
How could examples of good practice in the commissioning
and delivery of advocacy be collected, so as to inform regional
and national policy making?

Evaluation: measuring the impact of advocacy

The current situation
There is a small number of designated advocacy evaluation systems.
These tend either to focus on a schemes adherence to advocacy
principles, or to have a narrow focus on results. Some schemes have
independent evaluations carried out by consultants. Many schemes
have never been evaluated, and rely on routine monitoring to
demonstrate their worth. Formal evaluations tend to be expensive.

Problems and difficulties

Statutory funders of advocacy schemes are increasingly demanding
evidence of Best Value. Since there is no agreed definition of what


A right result?

constitutes good advocacy, there is a danger that too much emphasis

will be placed on simplistic measurement of throughput and results.
This may lead to entirely invalid comparisons between different forms
of advocacy. Worse still, it may lead to the rationing of advocacy, with
schemes only allowed to support partners for a few weeks at most.
This would destroy the principle of advocatepartner loyalty.

The advocacy movement should develop its own models for
monitoring and evaluation.
Different models of evaluation may be appropriate for different
forms of advocacy.
New types of evaluation could be based on the outline model
described in Chapter Five. Evaluation should cover all aspects
of a schemes work.
Evaluation should be transparent and credible. Evaluation
systems need to be promoted so that they are recognised and
accepted by funders and other interested parties.
Evaluation should not be too costly.

Topics for discussion

How can new systems of advocacy evaluation be created, or
existing ones developed?
What is the best way to establish the credibility of a system for
advocacy evaluation?

consensus within the advocacy movement?

funding from a research body to develop and pilot the


government backing for research and development?

devising a marketing strategy?

What sort of evaluation would be right for your scheme?



The current situation
Advocacy training tends to be organised on a scheme-by-scheme
basis and is linked to the particular form of advocacy. In citizen
advocacy, training is usually provided by scheme coordinators by way
of orientation for potential citizen advocates, who may also be given
opportunities to engage in further training if they so wish. Training
for professional casework advocates may include sessions on advocacy
and negotiation skills, relevant legislation and local service systems.
Training takes many forms including traditional classroom learning,
reading, role play and on-the-job training.
There is no nationally accredited training programme for advocates,
but new training initiatives are beginning to appear. BILDs Pathways
to citizen advocacy is one example. Elsewhere, universities are starting
to develop both academic and practical courses, sometimes in
partnership with local schemes.

Problems and difficulties

There is some concern within the advocacy movement that accredited
training would be the first step towards the professionalisation of
advocacy. Within citizen advocacy schemes, the concept of advocate
training is anathema in that citizen advocates are ordinary people
who bring their own skills, knowledge and experiences to the advocacy
relationship. Many citizen advocacy schemes do not even use the
term training to describe the support offered to advocates, preferring
orientation. Although many casework advocacy schemes place great
emphasis on training, it is not in the traditional sense of professional
career development. Rather, training equips advocates with the
knowledge and skills necessary to provide effective advocacy support
to a wide range of advocacy partners. There is no consensus on what
this training should consist of or how it should be provided. This may
be appropriate given the local nature of the majority of advocacy
schemes, but has the disadvantage of being ad hoc and not necessarily
well designed or delivered. Hence, not only do advocates receive
training which is inconsistent, but also advocacy partners have little
idea what to expect from their advocate.
There are two further issues that warrant consideration. First, it is


A right result?

a fact that there are now many hundreds of paid advocacy workers in
the UK, and those workers, if they are to be retained within the
advocacy sector, will require incentives of which training may be one
element. Second, statutory funders of advocacy schemes may well
see accredited training as a benchmark of quality and effectiveness
and therefore insist that schemes sign up to comprehensive advocacy
training programmes as they emerge.

Many of the existing advocacy networks mentioned previously
in this book have training as a high priority. As a result, it is
highly likely that we will see a proliferation of pilot accredited
training programmes over the next couple of years. This is no
bad thing; pilot schemes provide the opportunity to learn from
mistakes and build on successes. However, there is a danger of
duplication and a corresponding waste of precious resources if
those pilots are not linked up in some strategic way.
It is not clear whether any of the existing national networks is
in a position to take a lead on the issue of training but without
leadership, mistakes, overlap and duplication are inevitable. It is
essential that the advocacy movement appoints a national lead
agency for the coordination and dissemination of advocacy
training pilot schemes. It would also be advantageous to map
both the existing pilots and also potential funding sources and
partner agencies for the delivery of accredited training at a national
It is important that citizen advocacy schemes are not penalised
for their principled stance on training. Funders need to understand
why citizen advocacy adopts such a stance and should value the
role played by citizen advocates in the lives of devalued people.
The advocacy movement as a whole should be prepared to defend
citizen advocacy and ensure that a two-tier system of advocacy
is not allowed to develop.



Advocacy standards
The current situation
There is no consensus about whether national standards would
strengthen or undermine the UK advocacy movement. It is possible
to list both advantages and disadvantages of a system of national
advocacy standards. However, the advocacy movement faces many
threats to its identity and standards may present one way of
demonstrating both internal coherence and external effectiveness. If
the movement itself does not initiate standards they may well be
imposed by funders working to a Best Value agenda. Different forms
of advocacy may require different approaches in terms of the
mechanisms used to define quality and effectiveness.

Problems and difficulties

There is a danger that national standards would undermine local
ownership of advocacy schemes. There is also the issue of who is best
placed to lead the debate on standard setting, given that none of the
existing national advocacy bodies has such a mandate. It is difficult to
envisage a set of standards for advocacy which has relevance to all the
different advocacy forms.

The advocacy movement, and in particular the new National
Citizen Advocacy Network, should take the lead on developing
a set of standards for advocacy which are both robust and
These standards should cover:

access to advocacy

advocate preparation

advocacy processes

coping with risk

advocacy outcomes

and above all should define the concept of independence.


A right result?

There should be a working group established which includes

representatives from all the existing advocacy networks to take
these issues forward.
Standards should be developed which reflect and are relevant
to the different advocacy forms.

Topics for discussion

How do we involve advocacy partners and service users in the
debate about standards in a meaningful way?
Is it possible to devise standards that both meet funders
requirements and are appropriate to advocacy schemes?
What if advocacy schemes do not meet the pre-agreed
What infrastructure support exists to help schemes improve
their practice?
Agencies designed to support people who face difficulty or
disadvantage work under considerable pressures. Not the least of
these is a shortage of resources. The political currents of the past 20
years have consistently flowed towards lower taxation, and in doing
so have substantially eroded the belief in the comprehensive provision
of free health and social care. It is hard to think of a government
initiative on the NHS or community care in that time in which the
intention to save money, or at least to spend it more efficiently, has
not been a prominent feature. New regulations, too, and the need to
adopt new interventions and working practices, have left many of
these agencies highly managed and specialised.
There are some excellent services available; and few would wish to
return to the segregated and institutionalised care arrangements that
characterised the welfare state of the mid-20th century. However,
these services are more obviously rationed than ever before. Access
to housing, benefits and hospital surgery is rigorously scrutinised.
Services strive not only to meet needs, but also to manage them, and
in this they have a conflict of interests. It is the task of advocacy to
bear eloquent witness to this conflict, and to the toll it exacts on
peoples lives. The district council which refuses permanent
accommodation to a homeless single parent may be gatekeeping its
service admirably, and yet be committing a real injustice. It may be



cheaper for a local authority to place a disabled person in a hostel

rather than support them at home; but what price that persons
The more an individual is dependent on the support delivered by
agencies working under pressure, the less they are likely to ask for.
Their situation conveys to them the unspoken message be grateful
for what you have. Where needs are managed and not met, low
expectations prevail. Personal advocacy, which is most visible perhaps
in citizen and peer advocacy, challenges this climate by offering the
partner relationships and opportunities outside of the serviceclient
ethos, through which the partner can regain self-confidence and
articulate higher expectations. Technical advocacy promotes the
partners wishes by outflanking or demolishing the rules, arguments
or structures placed in their way.
Criticism is implicit in advocacy. If it is to highlight the many
instances where peoples needs are managed but not met, if it is to
speak up for those who would otherwise be ignored, it cannot be
part of the routine structures of care provision. Independence is for
this reason the hallmark of true advocacy, for independence creates
the space in which criticism can be formulated. This work has tried
to show what independence means in advocacy, and how it may best
be maintained and enhanced.
To say that advocacy is critical is not to say that it is negative, or
worse still self-righteous. Criticism can mean endorsement as well as
challenge. It refers above all to a process of testing; in the case of
advocacy, testing services and attitudes against the needs and wishes
of the individual. The critical nature of advocacy means that it will
always be developing, and will always be diverse. Different situations
highlight different advocacy needs, and diversity can be a sign of vitality.
However, if advocacy is to be something more that a series of wellmeaning aspirations, it must also be self-critical. Just as advocacy
schemes have found a range of ways in which one person can take
the side of another, so they must identify ways in which to record,
reflect on, and improve these results. Only in this way can advocacy
lay claim to the public resources it will need in order to flourish.
Ultimately, however, the significance of advocacy relates to much
broader questions than those pertaining to national standards or any
specific measurement of its impact. At the heart of advocacy is a
respect for the dignity of the human person, and a belief that voicing
this respect can have a transforming effect on both the individual and
on society at large. Advocacy is a living reminder of the possibilities


A right result?

of democracy where this is understood, not as majority rule, but as

the accountability of all social structures to that which is best, and
most profound, in the human person.


References and further reading

Advocacy 2000 (2000) Key ideas on independent advocacy, Edinburgh:

Advocacy 2000.
ANN (Advocacy Network Newcastle) (1995) Introducing ANNETTE,
Newcastle upon Tyne: Newcastle Council for Voluntary Service.
Atkinson, D. (1999) Advocacy: A review, Brighton: Pavilion.
Bateman, N. (2000) Advocacy skills for health and social care professionals,
London: Jessica Kingsley.
Bebbington, E., Feeney, S, J., Flannigan, C.B., Glover, G.R., Lewis, S.W.
and Wing, J.K. (1994) Inner London collaborative audit of admissions
in two health districts: ethnicity and the use of the Mental Health
Act, British Journal of Psychiatry, vol 165, pp 743-9.
Brandon, D. with Brandon, A. and T. (1995) Advocacy: Power to people
with disabilities, Birmingham:Venture Press.
Brooke, J. and Harris, J. (2000) Pathways to citizen advocacy Parts 1 and 2,
Kidderminster: BILD Publications.
Butler, K., Carr, S. and Sullivan, F. (1988) Citizen advocacy: A powerful
partnership, London: National Citizen Advocacy.
Campbell, P. (1991) Mental health self-advocacy in the UK, inV. Franson
(ed) Mental health services in the United States and England: Struggling for
change, London: MIND Publications.
Chappell, A.L. (1992) Towards a sociological cr itique of the
normalisation principle, Disability, Handicap and Society, vol 7, no 1, pp
Conlan, E. (1994) Advocacy Code of Practice, Sheffield: UKAN.
DETR (Department of the Environment, Transport and the Regions)
(1999) DETR Circular 10/99: Local Government Act 1999: Part I Best
Value, London: DETR.
DoH (Department of Health) (2000) The NHS Plan:A plan for investment,
a plan for reform, London: DoH.


A right result?

DoH (2001) Valuing people: A new strategy for learning disability for the 21st
century, London: DoH.
Fernando, S. (1991) Mental health, race and culture, London: Macmillan.
Francis, E., David, J., Johnson, N. and Sashidaran, S.P. (1989) Black
people and psychiatry in the UK, Psychiatric Bulletin, vol 13, pp 482-5.
GLAD (Greater London Association of the Disabled) (1995) The GLAD
guide to advocacy, London: GLAD.
Hadlow, J. (1996) Citizen advocacy observed: tool or tokenism?, Journal
of Community and Applied Psychology, vol 6, pp 403-8.
Hanley, B. and Davies, S. (1998) CAIT: Citizen advocacy evaluation pack,
London: CAIT.
Klijnsma, M.P. (1993) Patient advocacy in the Netherlands, Psychiatric
Bulletin, vol 17, pp 230-1.
Leader,A. and Crosby, J. (1998) Power tools:A resource pack for those committed
to the development of mental health advocacy into the millennium, Brighton:
Pavilion Publishing.
MIND (1992) The MIND guide to advocacy in mental health: Empowerment
in action, London: MIND Publications.
OBrien, J. (1987) Learning from citizen advocacy programs, Atlanta: GA:
Georgia Advocacy Office.
OBrien, J. and Wolfensberger, W. (1979) CAPE: Standards for citizen
advocacy program evaluation, Toronto, Canada: NIMR.
Read, J. and Wall Craft, J. (1994) A guide to advocacy for mental health
workers, London: MIND/UNISON.
Robson, G. (1987) Nagging: models of advocacy, in I. Barker and E.
Peck (eds) Power in strange places, London: Good Practice in Mental
Rogers, A. and Pilgrim, D. (1996) Mental health policy in Britain: A critical
introduction, Basingstoke: Macmillan.
Sang, B. and OBrien, J. (1984) Advocacy:The UK and American experience,
London: Kings Fund.
Scottish Executive (2000) Independent advocacy: A guide for commissioners,
Edinburgh: Scottish Executive.


References and further reading

Silvera, M. and Kapasi, R. (2000) Health advocacy for minority ethnic

Londoners, London: Kings Fund.
Simons, K. (1993) Citizen advocacy: The inside view, Bristol: Norah Fry
Research Institute, University of Bristol.
UKAN (United Kingdom Advocacy Network) (1997) Advocacy:A Code
of Practice, London: NHS Executive.
Ward, L. (ed) (1998) Innovations in advocacy and empowerment for people
with intellectual disabilities, Chorley: Lisiev & Hall.
Webb, B. and Holly, L. (1992) Citizen advocacy in practice, London:
Tavistock Institute.
Webb, B. and Holly, L. (1994) Evaluating a citizen advocacy scheme, Findings,
Social Care Research 52,York: Joseph Rowntree Foundation.
Wertheimer, A. (1996) Speaking out: Advocacy and older people, London:
Centre for Policy on Ageing.
Wertheiner, A. (1998) Citizen advocacy: A powerful partnership, London:
Williams, P. (ed) (1998) Standing by me: Stories of citizen advocacy, London:
Wills, A. (trans) (1956) The notebooks of Simone Weil, London: Routledge.
Wolfensberger,W. and Zahira, H. (eds) (1973) Citizen advocacy and protective
services for the impaired and handicapped, Toronto: NIMR.


abuse 40
in advocacy relationship 33, 34
prevention as advocacy outcome
77-8, 97
as advocacy outcome 70-2, 145
to advocacy 111, 113, 151
accreditation training 36, 136,
138-41, 149, 150
and national standards 9, 138, 139
definitions of 1-2, 114
terminology viii
Advocacy 2000 57, 59, 76, 88, 106,
108, 115
Advocacy for Accessing Services
advocacy commissioners 99-100
advocacy culture vi-vii, 39, 78-9,
development of 81-102
advocacy model 82-3
Advocacy Network Newcastle
(ANN) 45, 137
advocacy schemes
accreditation of 140
establishing identity 13-14, 101,
103, 104, 146-7
internal divisions in 37-8, 114
key outcomes 64-5, 66, 67-79,
93-7, 122, 145
lack of consistency in 14-15, 26-7
range of v, 13-14, 144-5
risk in 33-4, 69, 110, 112, 113
see also evaluation of advocacy
schemes; funding issues
attributes and skills 25
background of candidates 4
codes of practice for 57-8
dilemmas facing 59-64
evaluation of partnerships 43-4,
45, 94-6, 121-2

see also evaluation of advocacy

loyalty to partners 30-32, 40, 148
partnership dynamics 60-1
partnership roles 45
preparation of 111, 112, 125-9,
recruitment and selection 25-6,
risk to 33-4, 112, 113
support systems for 26, 30
supportive role 74-5
training and supervision 30, 36,
111, 112, 119, 125-41, 149-50
for citizen advocacy 111, 112,
125-9, 140-1, 149, 150
for professional casework
advocacy 129-41, 149
for volunteer advocacy 6, 132-41
AIDS 3, 28
ANNETTE evaluation model
45-56, 104
ambiguity of measurable
outcomes 49-51
measuring partnership activity
assertive outreach policies 5, 22
Atkinson, Dorothy vi-vii, 32, 37-8,
39-40, 76, 119
advocacy culture 78-9, 81, 84
autonomy see independence in
advocacy movement

Bateman, N. 11, 12, 32
befriending 75
best practice 14
BestValue initiative vii-viii, 19,
47-56, 65-6, 119, 147-8
and diversity of advocacy needs
inadequate in evaluation of
personal advocacy 81, 84


A right result?

BILD see British Institute of

Learning Disabilities
black people
mental health treatment 28-9
see also minority ethnic
Brandon, David 11, 74
British Council of Organisations of
Disabled People (BCODP) 6
British Institute of Learning
Disabilities (BILD) 117
Pathways to citizen advocacy 127-9,
141, 149
Brooke, J. 127-9
Butler, K. 2

CAIT see Citizen Advocacy
Information and Training
CAPE see Citizen Advocacy
Program Evaluation
care in the community see
community care
case studies in training 136
casework approach 54-5, 64-6, 112
see also professional casework
advocacy; technical advocacy
Certificate in Advocacy 136
child protection 69-70
choice as advocacy outcome 67-70,
76, 97, 145
see also access; empowerment
citizen advocacy v, viii, 2-5, 13
advocates 4
preparation of 111, 112, 125-9
recruitment and selection 5, 116
approach to training 112, 125-9,
140-1, 149, 150
assertive outreach policies 5, 22
confidentiality issues 90
disability movements distrust of
evaluation models 40-4, 45, 48,
funding 20-1, 21, 41, 44
good practice 14
idealism of 127


informal approach 116-17, 124

key features 4
partnership dynamics 60-1, 126
partnership stories vii, 61, 94-5, 96
Pathways to citizen advocacy 127-9,
141, 149
role of standards in 111, 112-13,
115-17, 124
and social development 74
styles of 63-4, 65-6, 89, 111
valued citizen concept 4, 37-8
see also volunteer advocacy
Citizen Advocacy Information and
Training (CAIT) 14, 35, 43-4,
98, 115, 117, 137
Citizen Advocacy Program
Evaluation (CAPE) 40-2, 43, 85,
98, 115-16
classroom learning 135-8
clinical advocacy 29
codes of practice 14, 19, 34, 57-8,
collective approach to advocacy 32
community care vii-viii
limitations of 3
role of advocacy v
standing of advocacy in 13
Community Care Charters 13
Community Health Councils vi, 87
competitive tendering for advocacy
services 19, 100, 147
complaints procedures 113, 151
confidentiality issues v, vii, 44, 77,
policy on 89-90, 113
consultation projects 106
see also Advocacy 2000
contract culture 46-7, 86-7
control issues 84-5, 91
Councils for Voluntary Service
(CVSs) 23, 24, 86
credibility of advocacy schemes 90,
crisis advocacy 5, 118
see also volunteer advocacy
culture see advocacy culture; service


Department of Health: Valuing
people v, 21-2, 101, 102, 114
Direct Action Network 32
disabled people
and citizen advocacy 2-5, 21,
37-8, 84
ownership of disability movement
84, 105
self-advocacy groups 6-7
vulnerability 3
Disabled Persons Act (1986) v, 21
Dorset Advocacy 95
drama in advocacy 60-3, 78

effectiveness of advocacy schemes
key outcomes 64-5, 66, 67-79,
93-7, 122, 145
see also evaluation of advocacy
schemes; outcomes
empowerment of users viii
as advocacy outcome 76-7, 97,
122, 145
and self-advocacy 76-7
see also choice as advocacy
equity in advocacy schemes 26-30,
ethnic minorities 28-30, 123
evaluation of advocacy schemes 15,
ambiguity of measurable
outcomes 49-51
costs of 98
feedback from partners 39, 52-4,
94, 96
issues arising from 35-6, 147-8
key outcomes 64-5, 66, 67-79,
93-7, 122, 145
models of 40-56, 97-9
monitoring advocacy 92-3, 113
national standards proposal vii, 9,
36, 93, 98, 103, 104, 107, 109
partnership stories 94-5, 96
and quality standards 110, 112-13
rationing agenda 54-5, 75, 148

see also outcomes

excluded groups 3

feedback from partners
lack of 39, 52-4
role in development of advocacy
culture 85-6, 94, 96
Francis, E. 29
funding issues v, vi, 18-22, 99-102,
145, 146
citizen advocacy 20-1, 21, 41, 44
conflicts of interest 9, 46, 73, 81,
99, 100, 101-2, 146, 147
excluded from advocacy model 83
from service providers 99-100,
101-2, 107, 146, 147-8
independent funding 20, 41
and monitoring and evaluation of
schemes 35, 41, 44, 45, 46, 147-8,
multi-source funding 21, 41
quality assurance 110
rationing agenda 54-5, 75, 91, 108,
standards for 107
tendering for advocacy 19, 100,
volunteer advocacy vi, 41
see also statutory funding issues

goal-achievement evaluations 50-1
good practice 14

halo/hero effect 52-3
Harris, J. 127-9
health advocacy standards 123
HIV/AIDS 3, 28

identity for advocacy 13-14, 101,
103, 104, 146-7
impact assessment 41-2, 44, 45


A right result?

independence in advocacy
movement vii-viii, 22-6, 30, 40,
143-4, 153
development of 81
causes compromises 46, 73, 81,
101-2, 146, 147
independent 20, 41
as separate issue 83
standards for 107
PALS compromise 87-8
standards for 103, 104, 106-9
individualism: constraints of 32

joining up 97
justice as advocacy outcome 72-3,
97, 145

see also evaluation of advocacy

schemes; outcomes
Mental Health Act (1983) 21, 29,
mental health reforms v, 119
Mental Health Task Force 29
mentally ill people
advocacy schemes for 21, 29
from minority ethnic
communities 28-9
vulnerability 3
minimum standards 106, 109-10,
116-17, 124
minority ethnic communities
28-30, 123
monitoring advocacy 92-3, 113
see also evaluation of advocacy
multi-source funding 21, 41

Kapasi, R. 123
Kings Fund 123

National Citizen Advocacy

Network (NCAN) 14, 21, 101,
114-15, 151
National Health Service (NHS)
Patient Advocacy and Liaison
Services v, vi, 22, 75, 87-8, 119
reforms v, 119
waiting lists initiative 49-50
National Health Service and
Community Care Act (1990) 21
national standards for advocacy vii,
9, 36, 93, 98, 103-24, 144, 151-3
and accreditation 36, 138, 139, 150
arguments for and against 103-6
for citizen advocacy 115-17
development proposals 106-14
for health advocacy 123
implementation proposals 114-15
minimum standards 106, 109-10,
116-17, 124
outline standards 113
for peer advocacy 122-3
for professional advocacy 119-22
quality assurance 103, 104, 110-14
framework for standards 111-13
for volunteer advocacy 118-19

law: legal advocacy 10-12, 29
learning disabled
advocacy schemes for 4, 21-2, 114
Pathway to citizen advocacy pack
127-9, 141, 149
as trainers 128, 129
vulnerability 3
legal advocacy 10-12, 29
literature on advocacy 137-8
local authorities see service culture/
loyalty between advocate and
partner 30-32, 40, 148

management of advocacy schemes
85-6, 107-8
measuring performance 15, 35-6,
ambiguity of measurable
outcomes 49-51



OBrien, John 3, 38, 40-1, 61
ombudsmen 10
on-the-job learning 132-4
ordinary person concept 4
organisational structure 23-5, 30,
86-7, 108-9, 143
key advocacy outcomes 64-5, 66,
67-79, 93-7, 122, 145
measures of 15, 35-6, 37-56
ambiguity of measurable
outcomes 49-51
partnership activity 94-6
see also evaluation of advocacy
outline standards 113
outreach policies 5, 22, 29
ownership issues 23-4, 83, 84-8, 101
effect of standards on 104, 105,
partners ownership 91, 133-4,
Patient Advocacy Liaison Service

PALS see Patient Advocacy and
Liaison Services
feedback from
lack of 39, 52-4
role in development of advocacy
culture 85-6, 94, 96
measuring partnership activity
94-6, 113, 121-2
ownership of advocacy 91, 133-4,
risk to 34, 78, 110, 112, 113
supportive relationship 74-5
partnership approach 65-6, 89
see also personal advocacy
partnership stories vii, 61, 94-5, 96
see also Williams: Standing by me
Pathways to citizen advocacy (BILD)
127-9, 141, 149

Patient Advocacy and Liaison

Services (PALS) v, vi, 22
and national standards 119
ownership issues 87-8
results-driven approach 75
peer advocacy v, 7-8, 13, 38, 61, 84,
key features 8
standards for 122-3
People First 6, 32
performance evaluation see
evaluation of advocacy schemes
Perkins, Dr Rachel 53, 63
personal advocacy 63-4, 65-6, 78,
145, 153
and access 71-2, 73
and choice 68-9, 70
effect of standards on 104, 111
ill-served by service model 81, 84,
91, 101
inseparable from technical
advocacy 89, 120-1
ownership issues 85
and social development 74
supportive role 74-5
and training 140
see also citizen advocacy; peer
advocacy; volunteer advocacy
physically disabled 3, 6-7
Pilgrim, D. 29
policy 89-90, 113
practice models 90-1
prevention as advocacy outcome
51-2, 77-8, 97, 118, 145
principles in advocacy 57-60
and advocacy culture 88-9
as basis for standards 106-7
professional casework advocacy v,
viii, 9-10, 13, 48, 89, 115
casework approach 54-5, 64-6,
confidentiality policy 89-90
conflicts of interest 9
funding 9
key features 10
standards for 119-22, 124
training for 129-41, 149
voluntary ethos 119-20


A right result?

see also service culture; technical

professionalisation of advocacy 9,
138, 139, 149
protection see child protection;
prevention as advocacy outcome
protgs 3, 51-2
see also partners

qualifications in advocacy 36, 138,
see also accreditation
quality assurance 92
standards for 103, 104, 110-14
and training 138, 150
see also accreditation; evaluation of
advocacy schemes; national

rationing agenda 54-5, 75, 91, 108,
recruitment and selection of
advocates 5, 25-6, 116
regulation of advocacy schemes
research on advocacy v, 137-8
risk management 33-4, 69-70, 78
role of quality standards 110, 112,
113, 151
see also abuse; prevention as
advocacy outcome
Rogers, A. 29
role play in training 134-5

St Andrews University: advocacy
courses 138
self-advocacy vii, 6-7, 13, 61, 84
and empowerment 76-7
key features 7
qualifications in 138
service culture/providers vii-viii
citizen advocacys rejection of


competition between 46-7

conflicts of interest vii-viii, 9,
101-2, 107
and evaluation of advocacy
schemes 46-56, 108
inadequate and inappropriate 81,
relationship with advocacy
schemes 90-1, 143
advocacy commissioners role
as funders of advocacy 99-100,
101-2, 107, 146, 147-8
need for independence from
86-7, 106, 107, 120-1, 152-3
standards for independence 106-9
suitability as advocacy providers
101, 152-3
see also statutory funding issues
Silvera, M. 123
social development as advocacy
outcome 74, 97, 145
social services 15
see also service culture/providers
spot purchased advocacy 48
standards see national standards for
Standing by me (Williams) vii, 30-1,
52, 68
statutory funding issues 18-22, 107,
conflicts of interest 9, 18-19, 46,
73, 81, 99-100, 101-2, 146
structure see organisational structure
styles of advocacy 58-79, 88-9
supervision of advocates 6, 15, 111
support systems for advocates 26,
supportive partnerships 74-5, 97
Survivors Speak Out 6, 32

technical advocacy 63-4, 65-6, 78,
84, 85, 145, 153
and access 70-1, 72
feedback on 94


inseparable from personal

advocacy 89, 120-1
and justice 72-3
only viable option for PALS 87
promotes choice 67-8, 69-70
role of standards 111, 112, 119-22
and support 74
time-limited advocacy 91, 148
and training 140
see also professional casework
tendering for advocacy services 19,
100, 147
time-limited advocacy 54-5, 75, 91,
108, 148
tokenism 118
training of advocates 6, 30, 36, 119,
125-41, 149-50
accreditation 9, 36, 136, 138-41,
149, 150
citizen advocacy approach 125-9,
149, 150
classroom learning 135-8
induction training 131
lack of 136
on-the-job learning 132-4
role play 134-5

key features 6
standards for 118-19, 124
training for 6, 132-41
see also citizen advocacy
vulnerable groups 3, 36, 110

waiting lists initiative 49-50
Weil, Simone 62
Williams, P.: Standing by me vii,
30-1, 52, 68
Wolfensberger, Wolf 2-4, 20-1, 40-1,
60-1, 63-4

United Kingdom Advocacy
Network (UKAN) 14, 35, 123
user involvement 23, 85-6
see also partners

valued citizen concept 4, 37-8
values in advocacy model 83-4, 93
Valuing people (White Paper) v, 21-2,
101, 102, 114
voluntary sector
conflicts of interest 23-4
contract culture 46-7
volunteer advocacy v, 5-6, 115
definition of 118
funding problems vi, 41